# PRIME HEALTHCARE SERVICES - LEAVENWORTH SURGERY CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Saint John Surgery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124489083
- **Authorized official:** RANDALL G NYP (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (913) 596-3930

## Contact information

- **Practice address:** 3550 S 4TH ST, SUITE G1, LEAVENWORTH, KS 66048-5071
- **Practice address phone:** (913) 680-6400
- **Mailing address:** 3500 S 4TH ST, LEAVENWORTH, KS 66048-5043
- **Mailing address phone:** (913) 680-6400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | KS | Yes |

## Other

- **Enumeration date:** 03/18/2016
- **Last updated:** 03/18/2016