Healthcare Provider Details

I. General information

NPI: 1477739803
Provider Name (Legal Business Name): MIDWEST DIVISION SPINE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 W 119TH ST SUITE 215
OVERLAND PARK KS
66209-3721
US

IV. Provider business mailing address

5701 W 119TH ST SUITE 215
OVERLAND PARK KS
66209-3721
US

V. Phone/Fax

Practice location:
  • Phone: 888-942-2774
  • Fax: 866-807-1897
Mailing address:
  • Phone: 888-942-2774
  • Fax: 866-807-1897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICK J KUENY
Title or Position: VP
Credential:
Phone: 816-276-9280