# COLLEGE PARK ANCILLARY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508203241
- **Authorized official:** TODD CARLON (VICE PRESIDENT)
- **Authorized official phone:** (816) 508-4090

## Contact information

- **Practice address:** 10600 MASTIN ST, OVERLAND PARK, KS 66212-5723
- **Practice address phone:** (913) 438-0868
- **Mailing address:** 11755 W 112TH ST, SUITE 202, OVERLAND PARK, KS 66210-2742
- **Mailing address phone:** (913) 469-0433

## Taxonomy

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

## Other

- **Enumeration date:** 06/03/2013
- **Last updated:** 06/04/2013