NPIMap

Organization Active NPI

Suburban Surgical Associates, Inc.

  • Surgery Physician
  • Saint Louis, MO
National Provider Identifier
1699802330
Registry record updated Jun 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
SUBURBAN SURGICAL ASSOCIATES, INC.
Practice address
555 N. New Ballas Rd
Suite 265
Saint Louis, MO 63141-6825
Phone
(314) 991-4644
Fax
(314) 991-4910
NPI assigned
Feb 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2010

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

Authorized official

Name
Ms. Lisa M Molloy, MBA
Title
Administrator
Phone
(314) 991-4644

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

555 N. New Ballas Rd
Suite 265
Saint Louis, MO 63141-6825

Mailing address

555 N. New Ballas Rd
Suite 265
Saint Louis, MO 63141-6825
Phone (314) 991-4644

Other identifiers 1

IdentifierTypeStateIssuer
507396109MedicaidMO

National Provider Directory

National Provider Directory

Locations

224 S Woods Mill Rd
Ste 220S
Chesterfield, MO 63017
Phone (314) 205-6491

555 N New Ballas Rd
Ste 265
Saint Louis, MO 63141
Phone (314) 991-4644

3009 N Ballas Rd
Ste 258
Saint Louis, MO 63131
Phone (314) 991-4664

Practitioners & affiliated clinicians

Practitioners 10

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": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277856000000",
    "number": "1699802330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 N. NEW BALLAS RD",
            "address_2": "SUITE 265",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416825",
            "telephone_number": "314-991-4644",
            "fax_number": "314-991-4910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 N. NEW BALLAS RD",
            "address_2": "SUITE 265",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416825",
            "telephone_number": "314-991-4644",
            "fax_number": "314-991-4910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUBURBAN SURGICAL ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2010-06-30",
        "status": "A",
        "authorized_official_last_name": "MOLLOY",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "314-991-4644",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507396109",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2010; 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.