Healthcare Provider Details

I. General information

NPI: 1558487009
Provider Name (Legal Business Name): MIDWEST DIGESTIVE HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 NE RALPH POWELL RD
LEES SUMMIT MO
64064-2358
US

IV. Provider business mailing address

3601 NE RALPH POWELL RD
LEES SUMMIT MO
64064-2358
US

V. Phone/Fax

Practice location:
  • Phone: 816-525-4440
  • Fax: 816-246-9887
Mailing address:
  • Phone: 816-525-4440
  • Fax: 816-246-9887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number121-7
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number121-2
License Number StateMO

VIII. Authorized Official

Name: WILLIAM SCOTT MONTGOMERY
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 816-525-4440