1063468361 NPI number — MIDWEST TRAUMA SERVICES, LLC

Table of content: (NPI 1063468361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063468361 NPI number — MIDWEST TRAUMA SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST TRAUMA SERVICES, LLC
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:
MIDWEST TRAUMA & SURGICAL SPECIALISTS
Provider Other Organization Name Type Code:
3
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:
1063468361
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2330 EAST MEYER BLVD
Provider Second Line Business Mailing Address:
T-207
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64132-4147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-276-9100
Provider Business Mailing Address Fax Number:
816-276-9101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2330 EAST MEYER BLVD
Provider Second Line Business Practice Location Address:
T-207
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64132-4147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-276-9100
Provider Business Practice Location Address Fax Number:
816-276-9101
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KUENY
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
J
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
816-276-9100

Provider Taxonomy Codes

  • Taxonomy code: 2086S0127X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 36082011 . This is a "BCBS OF KC (PHP)" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 507620607 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200356790 A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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