Healthcare Provider Details

I. General information

NPI: 1316851975
Provider Name (Legal Business Name): MIDWEST CENTER FOR ADVANCED SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9209 W 110TH ST
SHAWNEE MISSION KS
66210-1401
US

IV. Provider business mailing address

9209 W 110TH ST
SHAWNEE MISSION KS
66210-1401
US

V. Phone/Fax

Practice location:
  • Phone: 417-447-4484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: JEFF WONGSKHALUANG
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 417-447-4484