MEDICARE: WASHBURN SURGERY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	490004516	OTHER	KS	PALMETTO GBA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	112205	OTHER	KS	BCBS OF KS

General Provider Information

NPI Number	:	1306956818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASHBURN SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	619 SW CORPORATE VIEW
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66615-1233
Country	:	US
Telephone Number	:	785-235-3322
Fax Number	:	785-246-6258

Provider Business Practice Location Address
First Line	:	619 SW CORPORATE VIEW
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66615-1233
Country	:	US
Telephone Number	:	785-235-3322
Fax Number	:	785-246-6258

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN C. MARSH
Credential	:	M.D.
Telephone Number	:	785-235-3322

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	04/14/2008

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