| Organization Name: | ENDOSCOPY CENTER OF ST. LOUIS |
| NPI Number: | 1023094836 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES H. PETERSEN (PRESIDENT) |
| Mailing Address: | 200 Brevco Plaza Suite 207 Lake Saint Louis |
| State: | MO US |
| Postal Code: | 63367 |
| Phone Number: | 6365615450 |
| Fax Number: | 6365615451 |
| NPI Enumeration Date: | 12/22/2005 |
| NPI Last Update Date: | 11/27/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0800X |
| License Number: | 152-0 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Endoscopy |
| Taxonomy Definition: | |