Provider Demographics
NPI:1730183120
Name:COLORECTAL SURGERY ASSOCIATES PC
Entity type:Organization
Organization Name:COLORECTAL SURGERY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:
Authorized Official - Last Name:POLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-285-8479
Mailing Address - Street 1:6060 N OAK TRFY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-5130
Mailing Address - Country:US
Mailing Address - Phone:816-941-0800
Mailing Address - Fax:816-941-0080
Practice Address - Street 1:4370 W 109TH ST
Practice Address - Street 2:SUITE 350
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1361
Practice Address - Country:US
Practice Address - Phone:816-941-0800
Practice Address - Fax:816-941-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200298620AMedicaid
MO502936800Medicaid
MO502936800Medicaid
KSKA1885Medicare PIN