Healthcare Provider Details

I. General information

NPI: 1982211728
Provider Name (Legal Business Name): FT SCOTT SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 HIGHWAY 69
FORT SCOTT KS
66701-8885
US

IV. Provider business mailing address

11184 ANTIOCH RD STE 356
OVERLAND PARK KS
66210-2420
US

V. Phone/Fax

Practice location:
  • Phone: 620-223-0200
  • Fax:
Mailing address:
  • Phone: 913-787-6724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. NANCY J GRAVES
Title or Position: ACCOUNTANT
Credential:
Phone: 816-729-5602