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General NPI Number Information
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NPI Number | 1508813627
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Entity Type | Organization
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Legal Business Name | FOUR STATES SURGERY CENTER, PC
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 1905 W 32ND ST STE 201
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City | JOPLIN
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State | MO
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Zip | 64804-1512
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Country | US
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Telephone | 417-206-7900
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Fax | 417-206-3871
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Provider Business Mailing Address
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Address Line | 1531 EAST BRADFORD PARKWAY STE 100
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City | SPRINGFIELD
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State | MO
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Zip | 65804-6539
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Country | US
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Telephone | 417-887-3900
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Fax | 417-823-2894
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Authorized Official
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Title or Position | DIRECTOR OF REV CYCLE
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Name | MINDY RANDLES
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Credential |
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Telephone | 417-887-3900
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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 | 157-1
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License Number State | MO
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