Organization
STATELINE SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L MORRIS (ADMINISTRATOR)
(417) 625-9433
Entity
Organization
Contact information
Practice address
444 FOUR STATES DR, SUITE 2, GALENA, KS 66739
(417) 206-7846
Mailing address
PO BOX 305, WEIR, KS 66781-0305
(620) 396-8414
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
APPLYING
KS
Other
Enumeration date
03/12/2009
Last updated
12/16/2009
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