Provider Demographics
NPI:1497736805
Name:ST MARY'S SURGICAL CENTER INDEPENDENCE
Entity Type:Organization
Organization Name:ST MARY'S SURGICAL CENTER INDEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:816-874-4181
Mailing Address - Street 1:17000 E 40 HWY
Mailing Address - Street 2:SUITE 11
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5323
Mailing Address - Country:US
Mailing Address - Phone:816-777-1706
Mailing Address - Fax:816-777-1711
Practice Address - Street 1:203 NW RD MIZE ROAD
Practice Address - Street 2:SUITE 218
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014
Practice Address - Country:US
Practice Address - Phone:816-874-4181
Practice Address - Fax:816-874-4375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO9004256Medicare ID - Type Unspecified