Organization
INDEPENDENCE SURGICAL CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MINDI SUZANNE THOMPSON BEAHM MD (PRESIDENT)
(816) 373-4646
Entity
Organization
Contact information
Practice address
19550 EAST 39TH STREET S, SUITE 325, INDEPENDENCE, MO 64057-2310
(816) 373-4646
(816) 373-7831
Mailing address
19550 EAST 39TH STREET S, SUITE 325, INDEPENDENCE, MO 64057-2310
(816) 373-4646
(816) 373-7831
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
105155
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00486013
BCBS
MO
05
—
200395002
—
MO
Enumeration date
03/27/2007
Last updated
07/10/2024
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