MEDICARE: SURGICENTER OF KANSAS CITY, 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	90-7	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912993833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICENTER OF KANSAS CITY, LLC

Provider Business Mailing Address
First Line	:	701 E 101ST TER
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-4271
Country	:	US
Telephone Number	:	816-523-0100
Fax Number	:	816-995-3162

Provider Business Practice Location Address
First Line	:	701 E 101ST TERRACE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-4271
Country	:	US
Telephone Number	:	816-523-0100
Fax Number	:	816-995-3162

Authorized Official
Title or Position	:	VP/CFO
Name	:	DAVID MCKNIGHT
Credential	:
Telephone Number	:	972-789-2816

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	06/09/2026

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