Provider Demographics
NPI:1316620933
Name:ST. LOUIS CHILDREN'S SURGERY CENTER, LLC
Entity type:Organization
Organization Name:ST. LOUIS CHILDREN'S SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-340-1840
Mailing Address - Street 1:9709 LAKESIDE BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1213
Mailing Address - Country:US
Mailing Address - Phone:713-489-2198
Mailing Address - Fax:713-489-2978
Practice Address - Street 1:12184 NATURAL BRIDGE RD # 90
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2017
Practice Address - Country:US
Practice Address - Phone:314-391-4936
Practice Address - Fax:314-474-0191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-10
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical