1134225345 NPI number — MIDWEST MEDICAL SPECIALISTS PA

Table of content: (NPI 1134225345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134225345 NPI number — MIDWEST MEDICAL SPECIALISTS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST MEDICAL SPECIALISTS PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134225345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5330 N OAK TRFY
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64118-4699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-454-0666
Provider Business Mailing Address Fax Number:
816-454-1694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7450 KESSLER ST STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRIAM
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66204-2519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-722-0020
Provider Business Practice Location Address Fax Number:
816-559-7118
Provider Enumeration Date:
09/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KORANDA
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
816-454-0666

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CN3197 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".