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Organization

PHYSICIANS ALLIANCE LC

Active
Other names
Physicians Alliance Surgery Center
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JASON C BANDERMANN (ADMINISTRATOR)
(573) 334-1222
Entity
Organization

Contact information

Practice address
3241 PERCY DR, CAPE GIRARDEAU, MO 63701-4901
(573) 334-1222
(573) 334-3532
Mailing address
3241 PERCY DR, CAPE GIRARDEAU, MO 63701-4901
(573) 334-1222
(573) 334-3532

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
104-16
MO
261QM1300X
Multi-Specialty Clinic/Center
104-16
MO

Other

Enumeration date
10/21/2005
Last updated
04/04/2016
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