Healthcare Provider Details

I. General information

NPI: 1336364231
Provider Name (Legal Business Name): SURGERY CENTER AT LIBERTY HOSPITAL, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 GLENN HENDREN DR STE 100
LIBERTY MO
64068-9601
US

IV. Provider business mailing address

2529 GLENN HENDREN DR STE 100
LIBERTY MO
64068-9601
US

V. Phone/Fax

Practice location:
  • Phone: 816-883-2401
  • Fax: 816-883-2402
Mailing address:
  • Phone: 816-883-2401
  • Fax: 816-883-2402

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: MR. SANTOSH GEORGE, MD
Title or Position: GOVERNING BODY PRESIDENT
Credential: MD
Phone: 816-883-2401