Organization
SUBURBAN SURGICAL ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA M MOLLOY MBA (ADMINISTRATOR)
(314) 991-4644
Entity
Organization
Contact information
Practice address
555 N. NEW BALLAS RD, SUITE 265, SAINT LOUIS, MO 63141-6825
(314) 991-4644
(314) 991-4910
Mailing address
555 N. NEW BALLAS RD, SUITE 265, SAINT LOUIS, MO 63141-6825
(314) 991-4644
(314) 991-4910
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
507396109
—
MO
Enumeration date
02/28/2007
Last updated
06/30/2010
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