Basic Information
| Provider Information | |||||||||
| NPI: | 1811221252 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MID-AMERICA ORTHOPEDICS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1923 N WEBB RD | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672063405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166309300 | ||||||||
| FaxNumber: | 3168583201 | ||||||||
| Practice Location | |||||||||
| Address1: | 12112 W KELLOGG ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672351100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3164401100 | ||||||||
| FaxNumber: | 3164401089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2009 | ||||||||
| LastUpdateDate: | 06/11/2010 | ||||||||
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| AuthorizedOfficialLastName: | DO | ||||||||
| AuthorizedOfficialFirstName: | PAT | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3162624886 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MID-AMERICA ORHTOPEDICS LLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.