MEDICARE: MID STAR LAB INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1588194054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID STAR LAB INC

Provider Business Mailing Address
First Line	:	1701 COMMERCE RD
Second Line	:
City	:	TONGANOXIE
State	:	KS
Zip	:	66086-5369
Country	:	US
Telephone Number	:	913-369-8734
Fax Number	:

Provider Business Practice Location Address
First Line	:	5460 MAIN ST STE 106
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-5525
Country	:	US
Telephone Number	:	844-675-6757
Fax Number	:	844-409-6687

Authorized Official
Title or Position	:	CEO
Name	:	KARI WAGNER
Credential	:	C.PED
Telephone Number	:	913-369-8734

Provider Enumeration Date	:	06/15/2017
Last Update Date	:	02/04/2026

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Directions to “MID STAR LAB INC ” Practice Location

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