Healthcare Provider Details

I. General information

NPI: 1942272851
Provider Name (Legal Business Name): INDEPENDENCE ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 NE 79TH ST
KANSAS CITY MO
64158-1117
US

IV. Provider business mailing address

1A BURTON HILLS BLVD # L&C
NASHVILLE TN
37215-6187
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-4887
  • Fax:
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 Number158-0
License Number StateMO

VIII. Authorized Official

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