Organization
ENDOSCOPY CENTER OF ST. LOUIS, LLC
Active
Organization
ENDOSCOPY CENTER OF ST. LOUIS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM ANN LAWSON (OFFICE MANAGER)
(636) 561-5450
Entity
Organization
Contact information
Practice address
12990 MANCHESTER RD, SUITE 1, DES PERES, MO 63131-1804
(314) 984-0550
(314) 984-0501
Mailing address
200 BREVCO PLZ, SUITE 207, LAKE SAINT LOUIS, MO 63367-2949
(636) 561-5450
(636) 561-5451
Taxonomy
Speciality
Code
Description
License number
State
261QE0800X
Endoscopy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
195965
BLUE CROSS BLUE SHIELD
MO
01
—
P00214935
RR MEDICARE
MO
Enumeration date
04/16/2007
Last updated
11/29/2007
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