Manchester Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

163-1 Issued in MO

Legal business name

MANCHESTER SURGERY CENTER, LLC

Practice address

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

Phone

(314) 775-2264

Fax

(314) 775-2271

NPI assigned

Sep 2, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Melanie Kofron, RN

Title

Administrator

Phone

(314) 775-2264

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1157155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669574539",
    "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 SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KOFRON",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "314-775-2264",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MO",
            "license": "163-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary M Lewis, MA-CCCA
• Jeffery Raymond Link, DMD
• Cristen L Luehmann, MS, RLD
• Luxottica Retail North America Inc
• Manchester Ambulatory Surgery Center LP
• Frank J Marsilio, D.C.
• Kristin Marie Matushek
• Aleksei Phillip Maxwell
• Jean R McCammon, MSN, ANP-BC, ACNP-BC
• Earl Ellis McCrary III, PTA

• 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 Aug 22, 2020; 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.