Healthcare Provider Details

I. General information

NPI: 1770147217
Provider Name (Legal Business Name): ANDOVER AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 W 21ST ST STE 100
ANDOVER KS
67002-5500
US

IV. Provider business mailing address

1124 W 21ST ST
ANDOVER KS
67002-5500
US

V. Phone/Fax

Practice location:
  • Phone: 316-440-3200
  • Fax: 316-440-3255
Mailing address:
  • Phone: 316-201-6999
  • Fax: 316-300-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN HADLEY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 316-440-3200