NPIMap

Organization Active NPI

North Campus Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Creve Coeur, MO
National Provider Identifier
1073997144
Registry record updated Aug 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
264-0 Issued in MO
Legal business name
NORTH CAMPUS SURGERY CENTER LLC
Practice address
633 Emerson Rd
#120
Creve Coeur, MO 63141-6739
Phone
(314) 991-9922
Fax
(314) 991-6794
NPI assigned
Jul 17, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jenetha D Moran
Title
Officer/Authorized Official
Phone
(972) 763-3893

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X TBD MO
Ambulatory Surgical Clinic/Center 261QA1903X 264-0 MO Primary

Addresses

Primary practice location

633 Emerson Rd
#120
Creve Coeur, MO 63141-6739

Mailing address

15305 Dallas Pkwy Ste 1600
Addison, TX 75001-6491
Phone (972) 763-3893

Other names 1

  • North Campus Surgery Center Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

633 Emerson Rd
Ste 120
Saint Louis, MO 63141
Phone (314) 991-2090

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565654400000",
    "number": "1073997144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15305 DALLAS PKWY STE 1600",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750016491",
            "telephone_number": "972-763-3893",
            "fax_number": "972-692-6745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 EMERSON RD",
            "address_2": "#120",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631416739",
            "telephone_number": "314-991-9922",
            "fax_number": "314-991-6794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH CAMPUS SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-17",
        "last_updated": "2019-08-13",
        "status": "A",
        "authorized_official_last_name": "MORAN",
        "authorized_official_first_name": "JENETHA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OFFICER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "972-763-3893"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MO",
            "license": "TBD",
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MO",
            "license": "264-0",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Campus Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Campus Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Creve Coeur, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.