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General NPI Number Information
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NPI Number | 1316851975
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Entity Type | Organization
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Legal Business Name | MIDWEST CENTER FOR ADVANCED SURGERY, LLC
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Dates
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Enumeration Date | 09/30/2026
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Last Update Date | 09/30/2026
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Provider Practice Location Address
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Address Line | 9209 W 110TH ST
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City | SHAWNEE MISSION
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State | KS
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Zip | 66210-1401
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Country | US
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Telephone | 417-447-4484
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Fax |
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Provider Business Mailing Address
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Address Line | 9209 W 110TH ST
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City | SHAWNEE MISSION
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State | KS
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Zip | 66210-1401
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JEFF WONGSKHALUANG
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Credential | MD
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Telephone | 417-447-4484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | NULL
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