Basic Information
| Provider Information | |||||||||
| NPI: | 1588741235 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDWEST CARDIOVASCULAR & THORACIC SURGERY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 PROSPECT AVE | ||||||||
| Address2: | SUITE 546 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641321100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163337135 | ||||||||
| FaxNumber: | 8168220368 | ||||||||
| Practice Location | |||||||||
| Address1: | 6400 PROSPECT AVE | ||||||||
| Address2: | SUITE 546 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641321100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163337135 | ||||||||
| FaxNumber: | 8168220368 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 10/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | KUENY | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 6153737630 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 504452400 | 05 | MO | MEDICAID | 200426810A | 05 | KS | MEDICAID |