Healthcare Provider Details

I. General information

NPI: 1013963453
Provider Name (Legal Business Name): MIDWEST SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 MCCLELLAND BLVD
JOPLIN MO
64804-1640
US

IV. Provider business mailing address

PO BOX 2507
JOPLIN MO
64803-2507
US

V. Phone/Fax

Practice location:
  • Phone: 417-781-2807
  • Fax:
Mailing address:
  • Phone: 417-781-2807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number106-6
License Number StateMO

VIII. Authorized Official

Name: MARLENE M REINEKE
Title or Position: ADMINISTRATOR
Credential:
Phone: 417-781-2807