THE SURGERY CENTER OF ST. LOUIS, LLC (NPI# 1710066014) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710066014 |
| Entity Type | Organization |
| Organization Name | THE SURGERY CENTER OF ST. LOUIS, LLC |
| Practice Address |
12639 Old Tesson Rd Suite 130 Saint Louis MO 63128-2786 |
| Practice Telephone | 3147290785 |
| Practice Fax Number | 3148494637 |
| Mailing Telephone | 3147290785 |
| Mailing Fax Number | 3148494637 |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2008-04-14 |
| Authorized Official Name | MR. MICHAEL LADEVICH (CEO) |
| Authorized Official Telephone | 3148428655 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
129-2 | MO | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | RAILROAD MEDICARE | 490005357 | 01 |
| Street Address |
12639 OLD TESSON RD SUITE 130 |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63128-2786 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831191014 | Jeremy D Dunbarr | Physician Assistant | 12639 Old Tesson Rd, Suite 115, Saint Louis, MO 63128-2786 | 2005-06-01 |
| 1558978403 | Christopher Scott Thaller | Physical Therapist | 12639 Old Tesson Rd, Saint Louis, MO 63128-2711 | 2020-09-24 |
| 1225652514 | Erica Nicole Reeg | Nurse Practitioner | 12639 Old Tesson Rd, Saint Louis, MO 63128-2711 | 2020-06-02 |
| 1356615538 | Shayna Leigh Laramore | Nurse Practitioner | 12639 Old Tesson Rd, Suite, Saint Louis, MO 63128-2786 | 2012-03-06 |
| 1467729988 | Signature Medical Grou P of Kc, P.a. | Durable Medical Equipment & Medical Supplies | 12639 Old Tesson Rd, Suite 115, Saint Louis, MO 63128-2786 | 2011-11-29 |
| 1477876415 | Meghan C Flynn | Physician Assistant | 12639 Old Tesson Rd, Suite 115, Saint Louis, MO 63128-2786 | 2010-03-04 |
| 1376789362 | Dana Kay Mcquade | Physical Therapy Assistant | 12639 Old Tesson Rd, Suite 120, Saint Louis, MO 63128-2786 | 2008-12-23 |
| 1114171535 | Medical Implant Sloutions, LLC | Durable Medical Equipment & Medical Supplies | 12639 Old Tesson Rd, 116, Saint Louis, MO 63128-2786 | 2008-11-12 |
| 1154572170 | Signature Healthcare Foundation | Durable Medical Equipment & Medical Supplies | 12639 Old Tesson Rd, Suite 120, Saint Louis, MO 63128-2786 | 2008-10-08 |
| 1396991436 | Meghan D Sinon | Physician Assistant | 12639 Old Tesson Rd, Suite 115, Saint Louis, MO 63128-2786 | 2008-08-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235771155 | James T Fetsch Dmd LLC | Dentist | 10004 Kennerly Rd Suite 240, Saint Louis, MO 63128 | 2019-10-11 |
| 1326504655 | Nikodem Dental Holdings | Dentist | 4337 Butler Hill Rd Suite G, St Louis Mo, MO 63128 | 2019-02-12 |
| 1932678505 | Michelle Anne Arvidson | Physical Therapy Assistant | Elite Physical Therapy, 12608 Lamplighter Square Shopping Center, St. Louis, MO 63128 | 2018-11-13 |
| 1245726710 | Kristen Rider | Nurse Practitioner | 9964 Kennerly Rd Ste D, Saint Louis, MO 63128 | 2018-07-07 |
| 1306217427 | Sophia Bednarski | Dentist | 12660 Lamplighter Square Shopping Center, St. Louis, MO 63128 | 2015-10-15 |
| 1427434224 | Darcie Burrus | Counselor | 12523 Old Tesson Rd G, St Louis, MO 63128 | 2015-08-04 |
| 1710368584 | Sara Hawatmeh | Internal Medicine | 12345 W Bend Dr Ste 304, Saint Louis, MO 63128 | 2015-06-17 |
| 1871989590 | Celia Grace Montes-kolence | Speech-Language Pathologist | 12335 W Bend Drive, Saint Louis, MO 63128 | 2015-04-09 |
| 1245629302 | Marius Antonio Evans | Dentist | 9911 Kennerly Rd., Suite G, St. Louis, MO 63128 | 2015-01-13 |
| 1801230313 | Sarah Elizabeth Walsh | Emergency Medicine | 10010 Kennerly Road, Emergency Department, St. Anthony's Medical Center, St. Louis, MO 63128 | 2013-04-26 |
| Find all providers in zip 63128 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467925180 | Metro St Louis Surgery Center LLC | Clinic/Center | 1035 Bellevue Ave Ste 117, Saint Louis, MO 63117-1854 | 2019-01-04 |
| 1295207587 | Commons South Surgery Center, LLC | Clinic/Center | 12345 W Bend Dr Ste 201, Saint Louis, MO 63128-2254 | 2018-12-26 |
| 1922574391 | The Phoenix Oversight and Consulting, LLC. | Clinic/Center | 7746 Rannells Ave, Saint Louis, MO 63143-1823 | 2018-10-23 |
| 1700363611 | Apollo Ambulatory Surgery Center, LLC | Clinic/Center | 10012 Manchester Rd, Saint Louis, MO 63122-1826 | 2018-07-24 |
| 1730698374 | Advanced Surgical Center of Sunset Hills LLC | Clinic/Center | 4594 S Lindbergh Blvd, Saint Louis, MO 63127 | 2017-09-27 |
| 1093230450 | Center for Urologic Surgery LLC | Clinic/Center | 12855 N 40 Dr Ste 100, Saint Louis, MO 63141 | 2017-08-07 |
| 1114317757 | Midamerica Spine Center, LLC | Clinic/Center | 13627 Big Bend Rd, Saint Louis, MO 63122-3915 | 2015-02-04 |
| 1528210770 | South County Outpatient Endoscopy Services, Lp | Clinic/Center | 5139 Mattis Rd, Suite 100, Saint Louis, MO 63128 | 2008-10-21 |
| 1376692681 | Healthmark Brentwood LLC | Clinic/Center | 450 N Lindbergh Blvd Ste A, Saint Louis, MO 63141-7848 | 2007-01-09 |
| 1619026952 | Healthmark Ballas LLC | Clinic/Center | 456 N New Ballas Rd Ste 266, Saint Louis, MO 63141-6842 | 2007-01-09 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63128 |
Please comment or provide details below to improve the information on THE SURGERY CENTER OF ST. LOUIS, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.