MEDICARE: KC SURGICENTER, 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

General Provider Information

NPI Number	:	1962277483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KC SURGICENTER, LLC

Provider Business Mailing Address
First Line	:	1318 E 104TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-4504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1318 E 104TH STREET
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131
Country	:	US
Telephone Number	:	816-256-5200
Fax Number	:	816-256-5199

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

Provider Enumeration Date	:	11/15/2023
Last Update Date	:	06/09/2026

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Directions to “KC SURGICENTER, LLC ” Practice Location

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