| Organization Name: | PRIME HEALTHCARE SERVICES - LEAVENWORTH SURGERY CENTER, LLC |
| NPI Number: | 1124489083 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RANDALL G NYP (CHIEF EXECUTIVE OFFICER) |
| Mailing Address: | 3550 S 4th St Suite G1 Leavenworth |
| State: | KS US |
| Postal Code: | 660485071 |
| Phone Number: | 9136806400 |
| Fax Number: | |
| NPI Enumeration Date: | 03/18/2016 |
| NPI Last Update Date: | 03/18/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |