Organization
SKIN & MOHS SURGERY CENTER, LLC
Active
Parent organization
OLIVER STREET DERMATOLOGY HOLDINGS, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
OLIVER STREET DERMATOLOGY HOLDINGS, LLC
Authorized official
GLENN GOLDSTEIN M.D. (MEDICAL DIRECTOR)
(913) 451-7546
Entity
Organization
Contact information
Practice address
3265 NE RALPH POWELL RD, LEES SUMMIT, MO 64064-2301
(816) 524-4747
(816) 524-4929
Mailing address
3265 NE RALPH POWELL RD, LEES SUMMIT, MO 64064-2301
(816) 524-4747
(816) 524-9313
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
188-0
MO
Other
Enumeration date
11/14/2007
Last updated
04/27/2026
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