Provider Demographics
NPI:1568440493
Name:SURGICAL CARE OF INDEPENDENCE, INC
Entity Type:Organization
Organization Name:SURGICAL CARE OF INDEPENDENCE, INC
Other - Org Name:SURGICAL CARE OF INDEPENDENCE, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VAUGHN
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:LANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-254-9292
Mailing Address - Street 1:19101 E. VALLEY VIEW PARKWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6907
Mailing Address - Country:US
Mailing Address - Phone:816-254-9292
Mailing Address - Fax:816-795-8996
Practice Address - Street 1:19101 E. VALLEY VIEW PARKWAY
Practice Address - Street 2:SUITE B
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6907
Practice Address - Country:US
Practice Address - Phone:816-254-9292
Practice Address - Fax:816-795-8996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO214000OtherMEDICARE ID
MO500010509Medicaid
MO00508018OtherBCBS KC