Healthcare Provider Details

I. General information

NPI: 1114969516
Provider Name (Legal Business Name): MOBILE SURGICAL LASERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11382 STRANG LINE RD
LENEXA KS
66215-4041
US

IV. Provider business mailing address

11382 STRANG LINE RD
LENEXA KS
66215-4041
US

V. Phone/Fax

Practice location:
  • Phone: 913-469-1100
  • Fax: 913-469-1107
Mailing address:
  • Phone: 913-469-1100
  • Fax: 913-469-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number10049
License Number StateKS

VIII. Authorized Official

Name: MR. R JAY BELLER I
Title or Position: PRESIDENT
Credential:
Phone: 913-469-1100