Organization
ST LOUIS SPECIALTY SURGICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID RUSSELL HORACE (ADMINISTRATOR)
(618) 973-8740
Entity
Organization
Contact information
Practice address
1028 S KIRKWOOD RD, KIRKWOOD, MO 63122-7222
(314) 394-2950
(314) 394-2953
Mailing address
1028 S KIRKWOOD RD, KIRKWOOD, MO 63122-7222
(314) 394-2950
(314) 394-2953
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2014001570
MO
Other
Enumeration date
08/26/2016
Last updated
08/26/2016
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