St. Louis Children'S Surgery Center, LLC
Organization Active NPI Ambulatory Surgical Clinic/Center · Bridgeton, MO
NPI 1316620933 · NPPES record last updated Jan 27, 2025
Key facts
- NPI
- 1316620933
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulatory Surgical Clinic/Center 261QA1903X
- Legal business name
- ST. LOUIS CHILDREN'S SURGERY CENTER, LLC
- Practice address
- 12184 Natural Bridge Rd # 90
Bridgeton, MO 63044-2017 - Phone
- (314) 391-4936
- Fax
- (314) 474-0191
- NPI assigned
- Aug 10, 2023
- Organization subpart
- No
Authorized official
- Name
- Devin Larsen
- Title
- Ceo
- Phone
- (208) 340-1840
Practitioners 1
-
Tony W. McClure, D.D.S.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240328000208 | MO | Part B Supplier - Ambulatory Surgical Center | 0648617456 | Practice locations: Bridgeton, MO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | Yes |
Addresses
Primary practice location
12184 Natural Bridge Rd # 90
Bridgeton, MO 63044-2017
Mailing address
9709 Lakeside Blvd Ste 350
Spring, TX 77381-1213
Phone (713) 489-2198
Other providers in Bridgeton, MO
- SSM Medical Group Inc.
- SSM Neurosciences Inc
- SSM Pharmacy @ Depaul
- St Louis County Otolaryngology LTD
- St. Louis Behavioral Health Services, LLC
- St. Louis General Surgery, PC
- Matthew W Stadnyk
- Sarah Staff
- Emily Stageberg
- Remiko Cerrie Stallings
All providers in Bridgeton, MO · Ambulatory Surgical Clinic/Center in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.