Provider Demographics
NPI:1437237401
Name:SURGERY CENTER OF LEAWOOD, LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF LEAWOOD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BOLDRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:816-260-7893
Mailing Address - Street 1:11413 ASH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1692
Mailing Address - Country:US
Mailing Address - Phone:913-661-9977
Mailing Address - Fax:913-661-9577
Practice Address - Street 1:11413 ASH ST STE 100
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1692
Practice Address - Country:US
Practice Address - Phone:913-661-9977
Practice Address - Fax:913-661-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSS046016261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCS046016OtherSTATE LICENSE NUMBER
SCS046016OtherSTATE LICENSE NUMBER