Organization Name:  NORTHEAST MISSOURI AMBULATORY SURGERY CENTER LLC


Practice Location:
98 MEDICAL DRIVE  HANNIBAL, MO 63401 US
Tel: 573-406-1301  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
Y	261QA1903X	Ambulatory Health Care Facilities Clinic/Center Ambulatory Surgical	MO	108

Other Provider Identifiers:

Issuer	Number	State	Type
HEALTHLINK PROVIDER ID	431607	MO	01
BCBS PROVIDER ID	143365	MO	01
RAILROAD MEDICARE	490004674	MO	01
	505073205	MO	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin