Healthcare Provider Details

I. General information

NPI: 1164486809
Provider Name (Legal Business Name): SAINT LUKE'S SURGICENTER - LEE'S SUMMIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 NE SAINT LUKES BLVD
LEES SUMMIT MO
64086-6000
US

IV. Provider business mailing address

PO BOX 7010
OVERLAND PARK KS
66207-0010
US

V. Phone/Fax

Practice location:
  • Phone: 816-347-5800
  • Fax: 816-347-5899
Mailing address:
  • Phone: 913-647-6475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number154-1
License Number StateMO

VIII. Authorized Official

Name: LARRY FREVERT
Title or Position: BOARD MEMBER
Credential:
Phone: 816-347-5800