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Organization
SEDALIA SURGERY CENTER, LLC
Active
Organization
SEDALIA SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHYLLIS FISCHER (BUSINESS OFFICE MANAGER)
(660) 829-4024
Entity
Organization
Contact information
Practice address
3310 W 10TH ST, SEDALIA, MO 65301-2111
(660) 829-4024
(660) 829-2971
Mailing address
3310 W 10TH ST, SEDALIA, MO 65301-2111
(660) 829-4024
(660) 829-2971
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
261QA1903X
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
43194001265301
TRICARE
MO
01
—
491944012
PRIVATE HEALTHCARE SYSTEM
MO
05
—
506013507
—
MO
01
—
91125019
BLUE CROSS BLUE SHIELD
MO
Enumeration date
11/11/2005
Last updated
07/07/2008
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