Andover Ambulatory Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

ANDOVER AMBULATORY SURGERY CENTER, LLC

Practice address

1124 W 21St St Ste 100
Andover, KS 67002-5500

Phone

(316) 440-3200

Fax

(316) 440-3255

NPI assigned

Apr 30, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Steven Hadley

Title

Chief Financial Officer

Phone

(316) 440-3200

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

Listed as

Andover Ambulatory Surgery Center LLCCCN 17C0001099

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Kansas Medical Center, LLC

  • Family Medicine Physician
  • Derby, KS
  • NPI 1407237381

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1556582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599523200000",
    "number": "1770147217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1124 W 21ST ST",
            "city": "ANDOVER",
            "state": "KS",
            "postal_code": "670025500",
            "telephone_number": "316-201-6999",
            "fax_number": "316-300-4040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 W 21ST ST STE 100",
            "city": "ANDOVER",
            "state": "KS",
            "postal_code": "670025500",
            "telephone_number": "316-440-3200",
            "fax_number": "316-440-3255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDOVER AMBULATORY SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-30",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A",
        "authorized_official_last_name": "HADLEY",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "316-440-3200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Andover Family Counseling, LLC
• Andover Family Medicine, LLC
• Andover KS Opco LLC
• Andover Medical Investors, LLC

• All providers in Andover, KS
• Ambulatory Surgical Clinic/Center in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.