Provider Demographics
NPI:1477625390
Name:CENTURY SURGICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:CENTURY SURGICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-231-9072
Mailing Address - Street 1:100 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-4744
Mailing Address - Country:US
Mailing Address - Phone:620-231-9072
Mailing Address - Fax:
Practice Address - Street 1:100 N PINE ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-4744
Practice Address - Country:US
Practice Address - Phone:620-231-9072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSS019001261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS130274OtherKS BLUE CROSS BLUE SHIELD
KS100359200AMedicaid
KS464183Medicaid
KS464183Medicaid
KS490004479Medicare ID - Type UnspecifiedKS RAILROAD MEDICARE