Provider Demographics
NPI:1164486809
Name:SAINT LUKE'S SURGICENTER - LEE'S SUMMIT
Entity Type:Organization
Organization Name:SAINT LUKE'S SURGICENTER - LEE'S SUMMIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREVERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-347-5800
Mailing Address - Street 1:11250 TOMAHAWK CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-2668
Mailing Address - Country:US
Mailing Address - Phone:913-647-6475
Mailing Address - Fax:
Practice Address - Street 1:120 NE SAINT LUKES BLVD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-6000
Practice Address - Country:US
Practice Address - Phone:816-347-5800
Practice Address - Fax:816-347-5899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO154-1261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO9004297Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER