Organization
ADVANCED ENDOSCOPY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER HARTSHORN (OFFICER/AUTHORIZED OFFICIAL)
(314) 800-2017
Entity
Organization
Contact information
Practice address
11525 OLDE CABIN ROAD, SUITE 101, CREVE COEUR, MO 63141-7146
(314) 400-9999
(314) 400-9990
Mailing address
11525 OLDE CABIN ROAD, SUITE 101, CREVE COEUR, MO 63141-7146
(314) 400-9999
(314) 400-9990
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
196006
BLUE CROSS BLUE SHIELD
—
05
—
507304905
—
MO
01
—
P00209165
RAILROAD MEDICARE
—
Enumeration date
11/03/2005
Last updated
11/08/2024
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