NPIMap

Organization Active NPI

Physician Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Rolla, MO
National Provider Identifier
1710926589
Registry record updated Aug 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
PHYSICIAN SURGERY CENTER LLC
Practice address
1500 Highway 72 East
Rolla, MO 65401
Phone
(573) 426-6301
Fax
(573) 426-6304
NPI assigned
Jun 6, 2006
Last updated
Aug 5, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2009

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

Authorized official

Name
Ann S Deters
Title
Pres
Phone
(217) 342-2255

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

1500 Highway 72 East
Rolla, MO 65401

Mailing address

PO Box 1294
1207 Network Centre Blvd
Effingham, IL 62401
Phone (217) 342-2255

Other identifiers 4

IdentifierTypeStateIssuer
P00443325OtherRAILROAD MEDICARE
514184OtherHEALTHLINK
168305OtherBCBS
511377OtherHEALTHLINK

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1249430400000",
    "number": "1710926589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1294",
            "address_2": "1207 NETWORK CENTRE BLVD",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "62401",
            "telephone_number": "217-342-2255",
            "fax_number": "217-342-2619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 HIGHWAY 72 EAST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "65401",
            "telephone_number": "573-426-6301",
            "fax_number": "573-426-6304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-06",
        "last_updated": "2009-08-05",
        "status": "A",
        "authorized_official_last_name": "DETERS",
        "authorized_official_first_name": "ANN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "217-342-2255"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00443325",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "514184",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "168305",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "511377",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rolla, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2009; 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.