Healthcare Provider Details

I. General information

NPI: 1790809234
Provider Name (Legal Business Name): CERTIFIED SURGICAL FIRST ASSISTANTS OF KANSAS CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 W 82ND ST #2
LENEXA KS
66215-4125
US

IV. Provider business mailing address

14201 W 82ND ST #2
LENEXA KS
66215-4125
US

V. Phone/Fax

Practice location:
  • Phone: 816-522-7899
  • Fax: 913-302-0669
Mailing address:
  • Phone: 816-522-7899
  • Fax: 913-302-0669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: TYRONE M TAYLOR
Title or Position: OWNER
Credential: CSA, SA-C
Phone: 816-522-7899