Manchester Ambulatory Surgery Center LP

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

163-1 Issued in MO

Legal business name

MANCHESTER AMBULATORY SURGERY CENTER LP

Doing business as

Manchester Surgery Center

Practice address

1040 Old Des Peres Rd
Des Peres, MO 63131-1865

Phone

(314) 775-2264

Fax

(314) 775-2271

NPI assigned

Feb 21, 2007

Organization subpart

No

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

Authorized official

Name

Alexandra O Jenkins

Title

Officer of General Partner Company

Phone

(972) 713-3514

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• Manchester Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Manchester Ambulatory Surgery Center LP

  • Ambulatory Surgical Clinic/Center
  • Saint Louis, MO
  • NPI 1740673953

  O20070522000045

  Same enrollment

Listed as

Manchester Ambulatory Surgery Center LP Dba Manchester Surgery CenterCCN 26C0001099

Medicare certification status

Terminated Voluntary: merger or closure, May 7, 2022From the Provider of Services file

Locations

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346716800000",
    "number": "1477698009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 OLD DES PERES RD",
            "city": "DES PERES",
            "state": "MO",
            "postal_code": "631311865",
            "telephone_number": "314-775-2264",
            "fax_number": "314-775-2271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 OLD DES PERES RD",
            "city": "DES PERES",
            "state": "MO",
            "postal_code": "631311865",
            "telephone_number": "314-775-2264",
            "fax_number": "314-775-2271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANCHESTER AMBULATORY SURGERY CENTER LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2012-09-04",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "ALEXANDRA",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OFFICER OF GENERAL PARTNER COMPANY",
        "authorized_official_telephone_number": "972-713-3514"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MO",
            "license": "163-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "716779",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "199232",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00286053",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507403707",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOL FECA",
            "identifier": "613137600",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH PLAN",
            "identifier": "242333",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Manchester Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anthony Gerard Leisure Jr.
• Mary M Lewis, MA-CCCA
• Jeffery Raymond Link, DMD
• Cristen L Luehmann, MS, RLD
• Luxottica Retail North America Inc
• Manchester Surgery Center, LLC
• Frank J Marsilio, D.C.
• Kristin Marie Matushek
• Aleksei Phillip Maxwell
• Jean R McCammon, MSN, ANP-BC, ACNP-BC

• Ambulatory Surgical Clinic/Center in Des Peres, MO
• Providers in Des Peres, MO by specialty
• Ambulatory Surgical Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.