MEDICARE: INDEPENDENCE ASC 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	158-0	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942272851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENCE ASC LLC

Provider Business Mailing Address
First Line	:	1A BURTON HILLS BLVD # L&C
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-6187
Country	:	US
Telephone Number	:	615-665-1283
Fax Number	:	615-234-1720

Provider Business Practice Location Address
First Line	:	9601 NE 79TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64158-1117
Country	:	US
Telephone Number	:	816-478-4887
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFREY E SNODGRASS
Credential	:
Telephone Number	:	615-665-1283

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	11/23/2022

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Directions to “INDEPENDENCE ASC LLC ” Practice Location

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