MEDICARE: SURGERY CENTER OF INDEPENDENCE LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1710910922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGERY CENTER OF INDEPENDENCE LP

Provider Business Mailing Address
First Line	:	19550 E 39TH ST S STE 100
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64057-1917
Country	:	US
Telephone Number	:	816-254-0214
Fax Number	:	816-254-0194

Provider Business Practice Location Address
First Line	:	19550 EAST 39TH STREET
Second Line	:	SUITE 100
City	:	INDEPENDENCE
State	:	MO
Zip	:	64050
Country	:	US
Telephone Number	:	816-254-0214
Fax Number	:	816-254-0194

Authorized Official
Title or Position	:	VP/CFO
Name	:	DAVID MCKNIGHT
Credential	:
Telephone Number	:	972-789-2816

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	06/04/2026

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