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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