Organization
MASON RIDGE AMBULATORY SURGERY CENTER, LP
Active
Other names
Mason Ridge Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
KATHERINE L REED (OFFICER, AUTHORIZED OFFICIAL)
(972) 763-3859
Entity
Organization
Contact information
Practice address
12855 N 40 DR, STE 100, SAINT LOUIS, MO 63141-8657
(314) 878-7150
(314) 878-3051
Mailing address
12855 N 40 DR, STE 100, SAINT LOUIS, MO 63141-8657
(314) 878-7150
(314) 878-3051
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
201-7
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
204703
BLUE CROSS BLUE SHIELD
MO
05
—
500092309
—
MO
Enumeration date
02/21/2007
Last updated
08/26/2014
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