Healthcare Provider Details

I. General information

NPI: 1386166536
Provider Name (Legal Business Name): MID STAR LAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 W 34TH ST STE 710
KANSAS CITY MO
64111-7511
US

IV. Provider business mailing address

1701 COMMERCE RD
TONGANOXIE KS
66086-5369
US

V. Phone/Fax

Practice location:
  • Phone: 816-839-4771
  • Fax:
Mailing address:
  • Phone: 913-369-8734
  • Fax: 844-409-6687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: HEATHER DAWN O'BRIEN
Title or Position: OWNER/ CEO
Credential:
Phone: 913-369-8734