Basic Information
| Provider Information | |||||||||
| NPI: | 1689034472 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MID-AMERICA ORTHOPEDICS KC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4940 W 137TH ST STE B | ||||||||
| Address2: | |||||||||
| City: | LEAWOOD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662243633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132329846 | ||||||||
| FaxNumber: | 9132329817 | ||||||||
| Practice Location | |||||||||
| Address1: | 4940 W 137TH ST STE B | ||||||||
| Address2: | |||||||||
| City: | LEAWOOD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132329846 | ||||||||
| FaxNumber: | 9132329817 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2016 | ||||||||
| LastUpdateDate: | 04/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | DO | ||||||||
| AuthorizedOfficialFirstName: | PAT | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD/CEO | ||||||||
| AuthorizedOfficialTelephone: | 9132329846 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.