Provider Demographics
NPI:1770581829
Name:PHYSICIANS' SURGERY CENTER, LLC
Entity type:Organization
Organization Name:PHYSICIANS' SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:M
Authorized Official - Last Name:WHITACRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-384-9600
Mailing Address - Street 1:3840 W 75TH ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-4126
Mailing Address - Country:US
Mailing Address - Phone:913-384-9600
Mailing Address - Fax:913-384-9646
Practice Address - Street 1:3840 W 75TH ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-4126
Practice Address - Country:US
Practice Address - Phone:913-384-9600
Practice Address - Fax:913-384-9646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSS046015261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS55156OtherHUMANA
KS27008OtherCOVENTRY HEALTHCARE OF KS
90910016OtherBLUE CROSS BLUE SHIELD
KS=========OtherUNITEDHEALTHCARE OF THE M
90910016OtherBLUE CROSS BLUE SHIELD
KS========= 0001OtherCIGNA HEALTHCARE
KS=========OtherTAX ID NUMBER