Healthcare Provider Details

I. General information

NPI: 1164630521
Provider Name (Legal Business Name): KANSAS CITY SURGICAL ASSISTING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18100 E 215TH ST
PECULIAR MO
64078-9200
US

IV. Provider business mailing address

18100 E 215TH ST
PECULIAR MO
64078-9200
US

V. Phone/Fax

Practice location:
  • Phone: 816-304-7107
  • Fax: 816-380-6529
Mailing address:
  • Phone: 816-304-7107
  • Fax: 816-380-6529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number146414
License Number StateMO

VIII. Authorized Official

Name: MS. LINDA G. FREY
Title or Position: PRESIDENT
Credential: RNFA
Phone: 816-304-7107