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General NPI Number Information
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NPI Number | 1164045126
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Entity Type | Organization
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Legal Business Name | MID-AMERICA ORTHOPEDICS KC LLC
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Dates
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Enumeration Date | 05/26/2020
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Last Update Date | 05/26/2020
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Provider Practice Location Address
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Address Line | 7820 W 165TH ST
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City | OVERLAND PARK
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State | KS
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Zip | 66223-2925
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Country | US
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Telephone | 913-232-9846
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Fax | 913-232-9817
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Provider Business Mailing Address
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Address Line | 7820 W 165TH ST
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City | OVERLAND PARK
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State | KS
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Zip | 66223-2925
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Country | US
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Telephone | 913-232-9846
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Fax | 913-232-9817
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | JARILYN BOLANDER
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Credential |
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Telephone | 913-232-9846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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