Healthcare Provider Details

I. General information

NPI: 1477586030
Provider Name (Legal Business Name): MIDWEST SURGICAL, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2237 KEYSTONE CIR STE C
ANDOVER KS
67002-8742
US

IV. Provider business mailing address

2237 KEYSTONE CIR STE C
ANDOVER KS
67002-8742
US

V. Phone/Fax

Practice location:
  • Phone: 316-687-1090
  • Fax: 316-687-2234
Mailing address:
  • Phone: 316-687-1090
  • Fax: 316-687-2234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JACE W. HYDER
Title or Position: OWNER/MANAGER
Credential: M.D.
Phone: 316-687-1090