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General NPI Number Information
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NPI Number | 1962661736
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Entity Type | Organization
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Legal Business Name | MID AMERICA NEUROSPINE LLC
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 5701 W 119TH ST SUITE 331
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City | OVERLAND PARK
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State | KS
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Zip | 66209-3721
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Country | US
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Telephone | 913-851-2919
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Fax |
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Provider Business Mailing Address
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Address Line | 15438 IRON HORSE CIR
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City | LEAWOOD
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State | KS
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Zip | 66224-3852
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Country | US
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Telephone | 913-851-2919
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. ERNEST JEROME HANSON
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Credential | M.D.
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Telephone | 913-851-2919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 04-16128
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License Number State | KS
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