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General NPI Number Information
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NPI Number | 1962431197
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Entity Type | Organization
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Legal Business Name | SHAWNEE MISSION SURGERY CENTER LLC
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 12/11/2019
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Provider Practice Location Address
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Address Line | 9301 W 74TH ST STE 300
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City | MERRIAM
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State | KS
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Zip | 66204-2239
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Country | US
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Telephone | 913-632-9320
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Fax | 913-789-1886
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Provider Business Mailing Address
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Address Line | 7315 E FRONTAGE RD STE 200
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City | MERRIAM
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State | KS
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Zip | 66204-1658
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Country | US
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Telephone | 913-676-7770
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Fax | 913-676-7776
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Authorized Official
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Title or Position | EXEC VP & CFO
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Name | KARSTEN G RANDOLPH
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Credential |
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Telephone | 913-676-2152
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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 | S046018
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License Number State | KS
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