Provider Demographics
NPI:1306926761
Name:NORTH ST LOUIS COUNTY GENERAL SURGERY INC
Entity type:Organization
Organization Name:NORTH ST LOUIS COUNTY GENERAL SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANO
Authorized Official - Middle Name:NORIEGA
Authorized Official - Last Name:FLORO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:314-838-5600
Mailing Address - Street 1:11115 NEW HALLS FERRY RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-7613
Mailing Address - Country:US
Mailing Address - Phone:314-838-5600
Mailing Address - Fax:314-838-5637
Practice Address - Street 1:11115 NEW HALLS FERRY RD
Practice Address - Street 2:SUITE 303
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-7613
Practice Address - Country:US
Practice Address - Phone:314-838-5600
Practice Address - Fax:314-838-5637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO19508778OtherMO TAX ID