MEDICARE: SURGERY CENTER AT LIBERTY HOSPITAL, L.L.C.

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

General Provider Information

NPI Number	:	1336364231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGERY CENTER AT LIBERTY HOSPITAL, L.L.C.

Provider Business Mailing Address
First Line	:	2529 GLENN HENDREN DR STE 100
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-9601
Country	:	US
Telephone Number	:	816-883-2401
Fax Number	:	816-883-2402

Provider Business Practice Location Address
First Line	:	2529 GLENN HENDREN DR STE 100
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-9601
Country	:	US
Telephone Number	:	816-883-2401
Fax Number	:	816-883-2402

Authorized Official
Title or Position	:	GOVERNING BODY PRESIDENT
Name	:	MR. SANTOSH GEORGE, MD
Credential	:	MD
Telephone Number	:	816-883-2401

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	04/28/2008

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