Provider Demographics
NPI:1780127696
Name:MISSOURI COMMONS SURGERY CENTER LLC
Entity type:Organization
Organization Name:MISSOURI COMMONS SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LAWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-378-5422
Mailing Address - Street 1:12607 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6313
Mailing Address - Country:US
Mailing Address - Phone:314-327-8070
Mailing Address - Fax:314-228-1891
Practice Address - Street 1:12607 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6313
Practice Address - Country:US
Practice Address - Phone:143-327-8070
Practice Address - Fax:314-228-1891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-25
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical