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Organization
FOUR STATES SURGERY CENTER, PC
Active
Organization
FOUR STATES SURGERY CENTER, PC
Active
Other names
Four States Surgery Center,
Organization subpart
No
Provider details
NPI number
Authorized official
MINDY RANDLES (DIRECTOR OF REV CYCLE)
(417) 887-3900
Entity
Organization
Contact information
Practice address
1905 W 32ND ST STE 201, JOPLIN, MO 64804-1512
(417) 206-7900
(417) 206-3871
Mailing address
1531 EAST BRADFORD PARKWAY STE 100, SPRINGFIELD, MO 65804-6539
(417) 887-3900
(417) 823-2894
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
157-1
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
504769902
—
MO
05
—
67868614-01
—
KS
05
—
M4120R05
—
OK
Enumeration date
05/27/2006
Last updated
02/27/2024
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