Provider Demographics
NPI:1346249604
Name:ST. MARY'S SURGICAL CENTER LLC
Entity type:Organization
Organization Name:ST. MARY'S SURGICAL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER, AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3859
Mailing Address - Street 1:203 NW R D MIZE RD
Mailing Address - Street 2:STE 218
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2510
Mailing Address - Country:US
Mailing Address - Phone:816-874-4181
Mailing Address - Fax:816-874-4375
Practice Address - Street 1:203 NW R D MIZE RD
Practice Address - Street 2:STE 218
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2510
Practice Address - Country:US
Practice Address - Phone:816-874-4181
Practice Address - Fax:816-874-4375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO156-0261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00218043OtherRAILROAD MEDICARE
MO507521706Medicaid
MO9004256Medicare PIN
MO26C0001067Medicare Oscar/Certification