Provider Demographics
NPI:1275564346
Name:CEDAR OAKS SURGERY CENTER LLC
Entity Type:Organization
Organization Name:CEDAR OAKS SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HECHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:660-747-8868
Mailing Address - Street 1:706 N BURKARTH RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-9303
Mailing Address - Country:US
Mailing Address - Phone:660-747-8868
Mailing Address - Fax:660-747-5481
Practice Address - Street 1:706 N BURKARTH RD
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-9303
Practice Address - Country:US
Practice Address - Phone:660-747-8868
Practice Address - Fax:660-747-5481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO165-0261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
91254019OtherBLUE CROSS BLUE SHIELD KC
P00275083OtherRAILROAD MEDICARE
MO507502300Medicaid
MO9004260Medicare ID - Type Unspecified