SAINT JOHN SURGERY CENTER
NPI 1124489083
Clinic/Center - Ambulatory Surgical in Leavenworth, KS
About Saint John Surgery Center NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SAINT JOHN SURGERY CENTER (NPI 1124489083) is a healthcare organization registered as an ambulatory surgical in Leavenworth, Kansas and active in the NPI registry since March 2016. The organization holds a CLIA Waiver certificate valid through September 21, 2026 and lists Randall G Nyp, Chief Executive Officer, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 17D1040476
Saint John Urgent Care · Leavenworth, KSOther Providers at the Same Location NPPES 15
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
LEAVENWORTH, KS 66048
LEAVENWORTH, KS 66048
LEAVENWORTH, KS 66048
LEAVENWORTH, KS 66048
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Prime Healthcare Services - Leavenworth Surgery Center, LLC's NPI number?
The NPI number for Prime Healthcare Services - Leavenworth Surgery Center, LLC is 1124489083. It was assigned to this organization in the NPPES registry on March 18, 2016. The provider is doing business as Saint John Surgery Center.
Where is Prime Healthcare Services - Leavenworth Surgery Center, LLC located?
Prime Healthcare Services - Leavenworth Surgery Center, LLC is located at 3550 S 4th St Suite G1, Leavenworth, KS 66048. The listed phone number is (913) 680-6400.
What is Prime Healthcare Services - Leavenworth Surgery Center, LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.
Does Prime Healthcare Services - Leavenworth Surgery Center, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 17D1040476) is associated with this NPI, valid through September 21, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Prime Healthcare Services - Leavenworth Surgery Center, LLC was last updated on March 18, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Saint John Surgery Center · NPI 1124489083
Ambulatory Surgical organization in Leavenworth, Kansas. Organization record, active in the CMS NPPES registry since March 18, 2016.
## Identity
- **NPI:** 1124489083 (Entity type: Organization)
- **Enumerated:** March 18, 2016
- **Primary specialty:** Clinic/Center - Ambulatory Surgical · taxonomy 261QA1903X
- **Legal business name:** Prime Healthcare Services - Leavenworth Surgery Center, Llc
- **Organization subpart:** No
- **Authorized official:** Randall Nyp, CHIEF EXECUTIVE OFFICER
## Practice location
- **Address:** 3550 S 4TH ST, SUITE G1, Leavenworth, KS 66048-5071
- **Phone:** (913) 680-6400
## Record status
- **NPPES last updated:** March 18, 2016
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1124489083) · Data from the CMS NPPES public registry.