Healthcare Provider Details

I. General information

NPI: 1376045146
Provider Name (Legal Business Name): SAINT LUKES SURGERY CENTER SHOAL CREEK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8860 NE 82ND TER
KANSAS CITY MO
64158-1313
US

IV. Provider business mailing address

901 E 104TH ST FL 6
KANSAS CITY MO
64131-4517
US

V. Phone/Fax

Practice location:
  • Phone: 816-437-8101
  • Fax:
Mailing address:
  • Phone: 816-502-0602
  • 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: TAYLOR WARICK
Title or Position: PRESIDENT, AMBULATORY SERVICES
Credential:
Phone: 816-502-3284