Organization Name:  SEDALIA SURGERY CENTER, LLC


Practice Location:
3310 W 10TH ST  SEDALIA, MO 65301 US
Tel: 660-829-4024  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
Y	261QA1903X	Ambulatory Health Care Facilities Clinic/Center Ambulatory Surgical	MO	261QA1903X

Other Provider Identifiers:

Issuer	Number	State	Type
TRICARE	43194001265301	MO	01
PRIVATE HEALTHCARE SYSTEM	491944012	MO	01
BLUE CROSS BLUE SHIELD	91125019	MO	01
PHP	91125019	MO	01
	506013507	MO	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin