1568440493 NPI number — SURGICAL CARE OF INDEPENDENCE, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568440493 NPI number — SURGICAL CARE OF INDEPENDENCE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL CARE OF INDEPENDENCE, INC
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:
SURGICAL CARE OF INDEPENDENCE, INC
Provider Other Organization Name Type Code:
4
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:
1568440493
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19101 E. VALLEY VIEW PARKWAY
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64055-6907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-254-9292
Provider Business Mailing Address Fax Number:
816-795-8996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19101 E. VALLEY VIEW PARKWAY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64055-6907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-254-9292
Provider Business Practice Location Address Fax Number:
816-795-8996
Provider Enumeration Date:
12/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LANDERS
Authorized Official First Name:
VAUGHN
Authorized Official Middle Name:
AARON
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
816-254-9292

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 214000 . This is a "MEDICARE ID" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 500010509 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00508018 . This is a "BCBS KC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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