Basic Information
| Provider Information | |||||||||
| NPI: | 1013901404 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDWEST HOSPITAL SPECIALISTS, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10901 GRANADA LN | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136601616 | ||||||||
| FaxNumber: | 9136601664 | ||||||||
| Practice Location | |||||||||
| Address1: | 10901 GRANADA LN | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136601616 | ||||||||
| FaxNumber: | 9136601664 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 10/06/2008 | ||||||||
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| AuthorizedOfficialLastName: | SIMMONS | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9136601616 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100357430A | 05 | KS | MEDICAID | 177826002 | 01 | OWCP DEEOIC DOL | OTHER | 504676008 | 05 | MO | MEDICAID | DB3032 | 01 | KS | RR MCR | OTHER | 100357430B | 05 | KS | MEDICAID | 177826001 | 01 | DOL FECA | OTHER | 24826016 | 01 | BCBS | OTHER | CG6035 | 01 | MO | RR MCR | OTHER |