# SKIN & MOHS SURGERY CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** OLIVER STREET DERMATOLOGY HOLDINGS
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1669577524
- **Legal business name:** OLIVER STREET DERMATOLOGY HOLDINGS
- **Authorized official:** DR. GLENN D GOLDSTEIN M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (913) 451-7546

## Contact information

- **Practice address:** 11550 GRANADA ST, LEAWOOD, KS 66211-1453
- **Practice address phone:** (913) 451-7546
- **Mailing address:** 11550 GRANADA ST, LEAWOOD, KS 66211-1453

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | S046023 | KS | Yes |

## Other

- **Enumeration date:** 09/14/2006
- **Last updated:** 04/27/2026