Organization Name: | ST. LOUIS WOMEN'S SURGERY CENTER, LLC |
NPI Number: | 1154400471 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL LADEVICH (CEO) |
Mailing Address: | 884 Woods Mill Rd Suite 100 Ballwin |
State: | MO US |
Postal Code: | 630113657 |
Phone Number: | 6367790079 |
Fax Number: | 6367790080 |
NPI Enumeration Date: | 11/06/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA1903X |
License Number: | 140-2 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Ambulatory Surgical |
Taxonomy Definition: |