Healthcare Provider Details

I. General information

NPI: 1962676304
Provider Name (Legal Business Name): 32ND STREET SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 E 32ND STREET SUITE 6
JOPLIN MO
64804-2925
US

IV. Provider business mailing address

1A BURTON HILLS BLVD
NASHVILLE TN
37215-6187
US

V. Phone/Fax

Practice location:
  • Phone: 417-627-9699
  • Fax: 417-627-9602
Mailing address:
  • Phone: 615-665-1283
  • Fax: 615-234-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number247-0
License Number StateMO

VIII. Authorized Official

Name: JEFFREY E. SNODGRASS
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1283