Provider Demographics
NPI:1881849297
Name:MALLEY SURGICAL WEIGHT LOSS CENTER
Entity Type:Organization
Organization Name:MALLEY SURGICAL WEIGHT LOSS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-647-0989
Mailing Address - Street 1:5820 LAMAR AVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2612
Mailing Address - Country:US
Mailing Address - Phone:913-492-2530
Mailing Address - Fax:913-492-2576
Practice Address - Street 1:5820 LAMAR AVE
Practice Address - Street 2:STE. 200
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-2612
Practice Address - Country:US
Practice Address - Phone:913-492-2530
Practice Address - Fax:913-492-2576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G97454Medicare UPIN
C52158Medicare UPIN