1538262118 NPI number — MERCURY SURGERY CENTER LLC

Table of content: (NPI 1538262118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538262118 NPI number — MERCURY SURGERY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCURY SURGERY CENTER 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:
Provider Other Organization Name Type Code:
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:
1538262118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 HEARTLAND DRIVE
Provider Second Line Business Mailing Address:
SUITE 1820
Provider Business Mailing Address City Name:
ST JOSEPH
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64506-6201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-364-2772
Provider Business Mailing Address Fax Number:
816-364-6620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 HEARTLAND DRIVE
Provider Second Line Business Practice Location Address:
SUITE 1820
Provider Business Practice Location Address City Name:
ST JOSEPH
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64506-6201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-364-2772
Provider Business Practice Location Address Fax Number:
816-364-6620
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARTAMIAN
Authorized Official First Name:
KRIKOR
Authorized Official Middle Name:
O
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
816-232-8877

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  1730 , 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)

  • Identifier: 500183504 . This is a "MEDICAID" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 200372560A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com