Provider Demographics
NPI:1144206665
Name:MOBERLY SURGERY CENTER LLC
Entity Type:Organization
Organization Name:MOBERLY SURGERY CENTER LLC
Other - Org Name:THE SURGERY CENTER OF NORTH CENTRAL MISSOURI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-263-1266
Mailing Address - Street 1:2103 SILVA LN
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-3660
Mailing Address - Country:US
Mailing Address - Phone:660-263-1266
Mailing Address - Fax:660-263-8377
Practice Address - Street 1:2103 SILVA LN
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-3660
Practice Address - Country:US
Practice Address - Phone:660-263-1266
Practice Address - Fax:660-263-8377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO164-0261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical