Organization
BEL CLAIR AMBULATORY SURGICAL TREATMENT CENTER, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID RUSSELL HORACE (ADMINISTRATOR)
(618) 235-2299
Entity
Organization
Contact information
Practice address
325 W LINCOLN ST, BELLEVILLE, IL 62220-1921
(618) 235-2299
(618) 235-2556
Mailing address
325 W LINCOLN ST, BELLEVILLE, IL 62220-1921
(618) 235-2299
(618) 235-2556
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
IL
367500000X
Certified Registered Nurse Anesthetist
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141065
MEDICARE PTAN
IL
Enumeration date
10/01/2015
Last updated
10/01/2015
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