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General NPI Number Information
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NPI Number | 1568422152
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Entity Type | Organization
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Legal Business Name | MID CONTINENT ORTHOPEDICS, P.A.
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 6634 W CENTRAL AVE
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City | WICHITA
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State | KS
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Zip | 67212-3315
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Country | US
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Telephone | 316-946-0096
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Fax | 316-946-9920
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Provider Business Mailing Address
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Address Line | PO BOX 12368
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City | WICHITA
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State | KS
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Zip | 67277-2368
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Country | US
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Telephone | 316-946-0096
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Fax | 316-946-9920
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN P ESTIVO
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Credential | D.O.
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Telephone | 316-946-0096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 05-25156
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License Number State | KS
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