=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811135353
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIDWEST TRANSPLANT NETWORK, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2009
-----------------------------------------------------
Last Update Date | 01/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 W 47TH PL SUITE 400
-----------------------------------------------------
City | WESTWOOD
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66205-1815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-262-1668
-----------------------------------------------------
Fax | 913-262-5130
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1900 W 47TH PL SUITE 400
-----------------------------------------------------
City | WESTWOOD
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66205-1801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-262-1668
-----------------------------------------------------
Fax | 913-262-5130
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MR. ROB LINDERER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 913-262-1668
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 17D0662524
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------