Organization
SURGERY CENTER OF LEAWOOD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS CHARLES BOLDRY DPM (CEO)
(816) 260-7893
Entity
Organization
Contact information
Practice address
11413 ASH ST STE 100, LEAWOOD, KS 66211-1692
(913) 661-9977
(913) 661-9577
Mailing address
11413 ASH ST STE 100, LEAWOOD, KS 66211-1692
(913) 661-9977
(913) 661-9577
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
S046016
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S046016
STATE LICENSE NUMBER
SC
Enumeration date
11/01/2006
Last updated
08/22/2020
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