Organization
FOUR STATES SURGERY CENTER, PC
Active
Other names
Four States Surgery Center,
Organization subpart
No
Provider details
NPI number
Authorized official
MINDY RANDLES (DIRECTOR OF REV CYCLE)
(417) 887-3900
Entity
Organization
Contact information
Practice address
1905 W 32ND ST STE 201, JOPLIN, MO 64804-1512
(417) 206-7900
(417) 206-3871
Mailing address
1531 EAST BRADFORD PARKWAY STE 100, SPRINGFIELD, MO 65804-6539
(417) 887-3900
(417) 823-2894
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
157-1
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
504769902
—
MO
05
—
67868614-01
—
KS
05
—
M4120R05
—
OK
Enumeration date
05/27/2006
Last updated
02/27/2024
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