1194010629 NPI number — SURGERY CENTER OF CAPE GIRARDEAU, LLC

Table of content: (NPI 1194010629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194010629 NPI number — SURGERY CENTER OF CAPE GIRARDEAU, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGERY CENTER OF CAPE GIRARDEAU, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WEST PARK SURGERY CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194010629
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11221 ROE AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
LEAWOOD
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66211-1922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-387-0510
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319 S SILVER SPRINGS RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CAPE GIRARDEAU
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-651-8900
Provider Business Practice Location Address Fax Number:
573-651-8907
Provider Enumeration Date:
06/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
TASSET
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
VICE CHAIRMAN, NUEHEALTH
Authorized Official Telephone Number:
913-387-0510

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  237-4 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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