Organization
COLLEGE PARK ANCILLARY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD CARLON (VICE PRESIDENT)
(816) 508-4090
Entity
Organization
Contact information
Practice address
10600 MASTIN ST, OVERLAND PARK, KS 66212-5723
(913) 438-0868
Mailing address
11755 W 112TH ST, SUITE 202, OVERLAND PARK, KS 66210-2742
(913) 469-0433
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
06/03/2013
Last updated
06/04/2013
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