Healthcare Provider Details

I. General information

NPI: 1548940984
Provider Name (Legal Business Name): GRENE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 09/18/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 N WEBB RD STE 101
WICHITA KS
67206-3434
US

IV. Provider business mailing address

15933 CLAYTON RD STE 210
BALLWIN MO
63011-2172
US

V. Phone/Fax

Practice location:
  • Phone: 316-684-5158
  • Fax:
Mailing address:
  • Phone: 636-227-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOSEPH GIRA
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 636-200-4393