Provider Demographics
NPI:1588486328
Name:KC SURGICAL SERVICES, LLC
Entity type:Organization
Organization Name:KC SURGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:480-702-9444
Mailing Address - Street 1:21200 S LAGRANGE RD # 322
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-2003
Mailing Address - Country:US
Mailing Address - Phone:708-571-0398
Mailing Address - Fax:844-427-2845
Practice Address - Street 1:4650 N CENTRAL AVE UNIT 166
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1071
Practice Address - Country:US
Practice Address - Phone:480-702-4444
Practice Address - Fax:844-427-2845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty