# CYPRESS SURGERY CENTER LLC

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

## Provider details

- **NPI number:** 1962455964
- **Authorized official:** JENNIFER BOYD BALDOCK (OFFICER AND AUTHORIZED OFFICIAL)
- **Authorized official phone:** (615) 234-5954

## Contact information

- **Practice address:** 9300 E 29TH ST N, SUITE 100, WICHITA, KS 67226-2182
- **Practice address phone:** (316) 634-0404
- **Practice address fax:** (316) 634-2995
- **Mailing address:** PO BOX 26168, OKLAHOMA CITY, OK 73126-0168
- **Mailing address phone:** (316) 634-0404
- **Mailing address fax:** (316) 634-2995

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | S087014 | KS | Yes |

## Other

- **Enumeration date:** 05/18/2006
- **Last updated:** 03/01/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100387620A | — | KS |
| 01 | — | 1512 | FEDERAL BLUE CROSS | KS |
| 01 | — | 490004999 | RAILROAD MEDICARE | KS |