Basic Information
| Provider Information | |||||||||
| NPI: | 1578556023 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDWEST EMERGENCY MEDICAL SERVICES PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MIDWEST EMERGENCY MEDICAL SERVICES PC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11157 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641190157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8553813941 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2800 CLAY EDWARDS DR | ||||||||
| Address2: | |||||||||
| City: | NORTH KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641163220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163467220 | ||||||||
| FaxNumber: | 8163467242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | RUSSELL | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8163467220 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MO | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 501983001 | 05 | MO | MEDICAID | 10408016 | 01 | MO | BCBS OF KCMO | OTHER | CD1534 | 01 | RR MEDICARE | OTHER | 10408026 | 01 | MO | BCBS OF KCMO WOUND CARE | OTHER | 6780000A | 01 | MO | MEDICARE ST JOE MO | OTHER |