Organization
OLIVE AMBULATORY SURGERY CENTER, LLC
Active
Other names
Olive Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
JENETHA D MORAN (OFFICER / AUTHORIZED OFFICIAL)
(972) 763-3893
Entity
Organization
Contact information
Practice address
12101 WOODCREST EXECUTIVE DR, STE 101, SAINT LOUIS, MO 63141-5047
(314) 576-4500
(314) 576-4503
Mailing address
12101 WOODCREST EXECUTIVE DR, STE 101, SAINT LOUIS, MO 63141-5047
(314) 576-4500
(314) 576-4503
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
177
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
507784403
—
MO
Enumeration date
11/22/2006
Last updated
01/05/2017
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