Organization
ADVANCED SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELINDA SMITH R.N. (ADMINISTRATOR)
(314) 205-1610
Entity
Organization
Contact information
Practice address
12607 OLIVE BLVD, SAINT LOUIS, MO 63141-6313
(314) 205-1610
(314) 205-1233
Mailing address
12607 OLIVE BLVD, SAINT LOUIS, MO 63141-6313
(314) 205-1610
(314) 205-1233
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
132-0
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
506126200
—
MO
Enumeration date
10/07/2005
Last updated
08/11/2014
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