Organization
THE SURGERY CENTER OF ST. LOUIS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL LADEVICH (CEO)
(314) 842-8655
Entity
Organization
Contact information
Practice address
12639 OLD TESSON RD, SUITE 130, SAINT LOUIS, MO 63128-2786
(314) 729-0785
(314) 849-4637
Mailing address
12639 OLD TESSON RD, SUITE 130, SAINT LOUIS, MO 63128-2786
(314) 729-0785
(314) 849-4637
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
129-2
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
490005357
RAILROAD MEDICARE
MO
Enumeration date
11/06/2006
Last updated
04/14/2008
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