Provider Demographics
NPI:1225036601
Name:TALLGRASS SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:TALLGRASS SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP, GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-296-3000
Mailing Address - Street 1:6001 SW 6TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66615-1011
Mailing Address - Country:US
Mailing Address - Phone:785-272-8807
Mailing Address - Fax:785-228-4733
Practice Address - Street 1:6001 SW 6TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66615-1011
Practice Address - Country:US
Practice Address - Phone:785-272-8807
Practice Address - Fax:785-228-4733
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOPEKA HOSPITAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-11
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSS089006261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100450050AMedicaid
509220OtherFIRST GUARD
KS130554OtherBCBS
4900569OtherRAILROAD MEDICARE
KS=========OtherHEALTH PARTNERS OF KANSAS
=========OtherTRICARE