Provider Demographics
NPI:1194010629
Name:SURGERY CENTER OF CAPE GIRARDEAU, LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF CAPE GIRARDEAU, LLC
Other - Org Name:WEST PARK SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE CHAIRMAN, NUEHEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:TASSET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-387-0510
Mailing Address - Street 1:11221 ROE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1922
Mailing Address - Country:US
Mailing Address - Phone:913-387-0510
Mailing Address - Fax:
Practice Address - Street 1:319 S SILVER SPRINGS RD
Practice Address - Street 2:SUITE B
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703
Practice Address - Country:US
Practice Address - Phone:573-651-8900
Practice Address - Fax:573-651-8907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO237-4261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical