Organization Name: | MIDWEST SURGERY CENTER, LLC |
NPI Number: | 1003171745 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SONJAY JOSEPH FONN (OWNER) |
Mailing Address: | 65 Doctors Park Suite B Cape Girardeau |
State: | MO US |
Postal Code: | 637034927 |
Phone Number: | 5738032007 |
Fax Number: | |
NPI Enumeration Date: | 07/09/2012 |
NPI Last Update Date: | 04/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA1903X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Ambulatory Surgical |
Taxonomy Definition: |