Healthcare Provider Details

I. General information

NPI: 1346249604
Provider Name (Legal Business Name): ST. MARY'S SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 NW R D MIZE RD STE 218
BLUE SPRINGS MO
64014-2510
US

IV. Provider business mailing address

203 NW R D MIZE RD STE 218
BLUE SPRINGS MO
64014-2510
US

V. Phone/Fax

Practice location:
  • Phone: 816-874-4181
  • Fax: 816-874-4375
Mailing address:
  • Phone: 816-874-4181
  • Fax: 816-874-4375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number156-0
License Number StateMO

VIII. Authorized Official

Name: MS. KATHERINE L REED
Title or Position: OFFICER, AUTHORIZED OFFICIAL
Credential:
Phone: 972-763-3859