Provider Demographics
NPI:1285358481
Name:PHYSICIANS AMBULATORY SURGERY CENTER LLC
Entity type:Organization
Organization Name:PHYSICIANS AMBULATORY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEDEFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-706-0560
Mailing Address - Street 1:114 PIPER HILL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1661
Mailing Address - Country:US
Mailing Address - Phone:636-706-0560
Mailing Address - Fax:636-244-1735
Practice Address - Street 1:114 PIPER HILL DR STE 101
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1661
Practice Address - Country:US
Practice Address - Phone:636-706-0560
Practice Address - Fax:636-244-1735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-30
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty