Healthcare Provider Details

I. General information

NPI: 1972579894
Provider Name (Legal Business Name): MIDWEST ORTHOPAEDICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 KESSLER ST STE 140
MERRIAM KS
66204-2519
US

IV. Provider business mailing address

7450 KESSLER ST STE 140
MERRIAM KS
66204-2519
US

V. Phone/Fax

Practice location:
  • Phone: 913-362-8317
  • Fax: 913-362-0169
Mailing address:
  • Phone: 913-362-8317
  • Fax: 913-362-0169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BARBARA SACK
Title or Position: EXECUTIVE DIRECTOR
Credential: MHSA
Phone: 913-362-8317