Provider Demographics
NPI:1538262118
Name:MERCURY SURGERY CENTER LLC
Entity type:Organization
Organization Name:MERCURY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIKOR
Authorized Official - Middle Name:O
Authorized Official - Last Name:PARTAMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-232-8877
Mailing Address - Street 1:901 HEARTLAND DRIVE
Mailing Address - Street 2:SUITE 1820
Mailing Address - City:ST JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-6201
Mailing Address - Country:US
Mailing Address - Phone:816-364-2772
Mailing Address - Fax:816-364-6620
Practice Address - Street 1:901 HEARTLAND DRIVE
Practice Address - Street 2:SUITE 1820
Practice Address - City:ST JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-6201
Practice Address - Country:US
Practice Address - Phone:816-364-2772
Practice Address - Fax:816-364-6620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1730261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500183504OtherMEDICAID
KS200372560AMedicaid
MO9004281Medicare ID - Type Unspecified