Provider Demographics
NPI:1285601989
Name:BELLEVUE SURGICAL ASSOCIATES, P. C.
Entity type:Organization
Organization Name:BELLEVUE SURGICAL ASSOCIATES, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:314-644-6300
Mailing Address - Street 1:1035 BELLEVUE AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1846
Mailing Address - Country:US
Mailing Address - Phone:314-644-6300
Mailing Address - Fax:314-644-2503
Practice Address - Street 1:1035 BELLEVUE AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1854
Practice Address - Country:US
Practice Address - Phone:314-644-6300
Practice Address - Fax:314-644-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8263208600000X
MOR9749208600000X
IL36097734208600000X
MO2003009024208600000X
MO2006001807208600000X
MO140041363LA2200X
MO063677363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO37022OtherGROUP HEALTH PLAN
MO20361OtherHEALTHCARE USA