Provider Demographics
NPI:1376045146
Name:SAINT LUKES SURGERY CENTER SHOAL CREEK, LLC
Entity Type:Organization
Organization Name:SAINT LUKES SURGERY CENTER SHOAL CREEK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, AMBULATORY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:WARICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-502-3284
Mailing Address - Street 1:901 E 104TH ST FL 6
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-502-0602
Mailing Address - Fax:
Practice Address - Street 1:8860 NE 82ND TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158-1313
Practice Address - Country:US
Practice Address - Phone:816-437-8101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical