Provider Demographics
NPI:1336289123
Name:CEDAR SURGICAL LLC
Entity Type:Organization
Organization Name:CEDAR SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR.
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGREEVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-616-6272
Mailing Address - Street 1:2237 KEYSTONE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002
Mailing Address - Country:US
Mailing Address - Phone:316-616-6272
Mailing Address - Fax:316-616-0407
Practice Address - Street 1:2237 KEYSTONE CIRCLE
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002
Practice Address - Country:US
Practice Address - Phone:316-616-6272
Practice Address - Fax:316-616-0407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS208600000X
208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200426030AMedicaid
KS200426030AMedicaid