Healthcare Provider Details

I. General information

NPI: 1770581829
Provider Name (Legal Business Name): PHYSICIANS' SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 W 75TH ST
PRAIRIE VILLAGE KS
66208-4126
US

IV. Provider business mailing address

3840 W 75TH ST
PRAIRIE VILLAGE KS
66208-4126
US

V. Phone/Fax

Practice location:
  • Phone: 913-384-9600
  • Fax: 913-384-9646
Mailing address:
  • Phone: 913-384-9600
  • Fax: 913-384-9646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberS046015
License Number StateKS

VIII. Authorized Official

Name: DR. MARC M WHITACRE
Title or Position: CEO
Credential: MD
Phone: 913-384-9600