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General NPI Number Information
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NPI Number | 1437237401
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Entity Type | Organization
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Legal Business Name | SURGERY CENTER OF LEAWOOD, LLC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11413 ASH ST STE 100
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City | LEAWOOD
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State | KS
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Zip | 66211-1692
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Country | US
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Telephone | 913-661-9977
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Fax | 913-661-9577
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Provider Business Mailing Address
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Address Line | 11413 ASH ST STE 100
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City | LEAWOOD
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State | KS
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Zip | 66211-1692
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Country | US
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Telephone | 913-661-9977
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Fax | 913-661-9577
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Authorized Official
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Title or Position | CEO
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Name | THOMAS CHARLES BOLDRY
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Credential | DPM
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Telephone | 816-260-7893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | S046016
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License Number State | KS
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