Organization Name: | MANCHESTER AMBULATORY SURGERY CENTER LP |
NPI Number: | 1477698009 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ALEXANDRA O JENKINS (OFFICER OF GENERAL PARTNER COMPANY) |
Mailing Address: | 1040 Old Des Peres Rd Des Peres |
State: | MO US |
Postal Code: | 631311865 |
Phone Number: | 3147752264 |
Fax Number: | 3147752271 |
NPI Enumeration Date: | 02/21/2007 |
NPI Last Update Date: | 09/04/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA1903X |
License Number: | 163-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Ambulatory Surgical |
Taxonomy Definition: |