MEDICARE: MIDWEST ORTHOPEDIC RESOURSES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1154656759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST ORTHOPEDIC RESOURSES, LLC

Provider Business Mailing Address
First Line	:	1624 N CLARENCE AVE
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67203-1522
Country	:	US
Telephone Number	:	316-617-9625
Fax Number	:	316-260-3659

Provider Business Practice Location Address
First Line	:	1624 N CLARENCE AVE
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67203-1522
Country	:	US
Telephone Number	:	316-617-9625
Fax Number	:	316-260-3659

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. BRAD R BRANDT
Credential	:
Telephone Number	:	316-617-9625

Provider Enumeration Date	:	10/15/2009
Last Update Date	:	10/15/2009

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