Healthcare Provider Details

I. General information

NPI: 1497736805
Provider Name (Legal Business Name): ST MARY'S SURGICAL CENTER INDEPENDENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 NW RD MIZE ROAD SUITE 218
BLUE SPRINGS MO
64014
US

IV. Provider business mailing address

17000 E 40 HWY SUITE 11
INDEPENDENCE MO
64055-5323
US

V. Phone/Fax

Practice location:
  • Phone: 816-874-4181
  • Fax: 816-874-4375
Mailing address:
  • Phone: 816-777-1706
  • Fax: 816-777-1711

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: MR. ALAN GREENWOOD
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 816-874-4181