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Organization

OLIVE SURGERY CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. LUANN BROWN (DIVISION VP)
(404) 906-1510
Entity
Organization

Contact information

Practice address
12101 WOODCREST EXECUTIVE DR STE 101, CREVE COEUR, MO 63141-5047
(314) 576-4500
Mailing address
12101 WOODCREST EXECUTIVE DR. SUITE 101, CREVE COEUR, MO 63141
(314) 576-4500
(314) 576-4503

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
177-0
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
201928
BLUE CROSS BLUE SHIELD
AK
Enumeration date
07/01/2006
Last updated
12/06/2007
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