Provider Demographics
NPI:1962431197
Name:SHAWNEE MISSION SURGERY CENTER LLC
Entity type:Organization
Organization Name:SHAWNEE MISSION SURGERY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXEC VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:KARSTEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-676-2152
Mailing Address - Street 1:7315 E FRONTAGE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-1658
Mailing Address - Country:US
Mailing Address - Phone:913-676-7770
Mailing Address - Fax:913-676-7776
Practice Address - Street 1:9301 W 74TH ST STE 300
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-2239
Practice Address - Country:US
Practice Address - Phone:913-632-9320
Practice Address - Fax:913-789-1886
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAWNEE MISSION MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-01
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSS046018261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100415840AMedicaid
KS100415840AMedicaid