Healthcare Provider Details

I. General information

NPI: 1720902398
Provider Name (Legal Business Name): ASCENTIST ANESTHESIA GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 COLLEGE BLVD
LEAWOOD KS
66211-1602
US

IV. Provider business mailing address

5101 COLLEGE BLVD
LEAWOOD KS
66211-1614
US

V. Phone/Fax

Practice location:
  • Phone: 913-721-3387
  • Fax: 816-875-2597
Mailing address:
  • Phone: 913-721-3387
  • Fax: 816-875-2597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SARAH MIKULICH
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 913-392-2246