Organization
THE ST LOUIS MO ORTHOPAEDIC ASC LLC
Active
Other names
Des Peres Square Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP A CLENDENIN (PRESIDENT)
(615) 665-1283
Entity
Organization
Contact information
Practice address
1050 OLD DES PERES RD, SUITE 150, SAINT LOUIS, MO 63131-1873
(314) 569-2918
(314) 569-9473
Mailing address
1050 OLD DES PERES RD, SUITE 150, SAINT LOUIS, MO 63131-1873
(314) 569-2918
(314) 569-9473
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
171-1
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149879
BLUE CROSS BLUE SHIELD
MO
01
—
490005580
RAILROAD MEDICARE
MO
01
—
611789400
US DEPT OF LABOR
MO
01
—
TRICARE
260042667
MO
Enumeration date
02/21/2006
Last updated
09/07/2023
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