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NPI Code Detail

MEDICARE: MID-KANSAS WOUND SPECIALIST P A

MEDICARE: MID-KANSAS WOUND SPECIALIST P A
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
12083P0011XUndersea and Hyperbaric Medicine (Preventive Medicine) Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CI6093OTHERKSRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2110380OTHERKSBLUE CROSS GROUP #

General Provider Information

NPI Number : 1326076977
Entity Type Code : Organization
Provider Name (Legal Business Name) : MID-KANSAS WOUND SPECIALIST P A
Provider Business Mailing Address
First Line : PO BOX 801660
Second Line :
City : KANSAS CITY
State : MO
Zip : 64180-0001
Country : US
Telephone Number : 800-700-0278
Fax Number :
Provider Business Practice Location Address
First Line : 10346 E STONEGATE LN STE 100
Second Line :
City : WICHITA
State : KS
Zip : 67206-2054
Country : US
Telephone Number : 316-910-0024
Fax Number : 316-910-0023
Authorized Official
Title or Position : OWNER
Name : JUSTIN GOODEN
Credential :
Telephone Number : 972-786-4990
Provider Enumeration Date : 06/30/2006
Last Update Date : 10/19/2023

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