Healthcare Provider Details

I. General information

NPI: 1205936101
Provider Name (Legal Business Name): MOUNT VERNON SURGICAL CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E GAMBIER ST
MOUNT VERNON OH
43050-3510
US

IV. Provider business mailing address

9100 W 131ST CT
OVERLAND PARK KS
66213-4314
US

V. Phone/Fax

Practice location:
  • Phone: 740-392-7420
  • Fax:
Mailing address:
  • Phone: 913-681-3287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35-07-8185
License Number StateOH

VIII. Authorized Official

Name: DR. DANIEL S PALEY
Title or Position: PRESIDENT, SURGEON
Credential: M.D.
Phone: 740-392-5800