MEDICARE: MIDWEST AMERICA PLASTIC SURGERY CENTER, LTD

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	2086S0122X	Plastic and Reconstructive Surgery Physician	107537	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00877303	OTHER	MO	ARTICLE OF INCORPORATION FILE NUMBER

General Provider Information

NPI Number	:	1740581305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST AMERICA PLASTIC SURGERY CENTER, LTD

Provider Business Mailing Address
First Line	:	1421 W 47TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64112-1103
Country	:	US
Telephone Number	:	816-941-6226
Fax Number	:	816-941-6336

Provider Business Practice Location Address
First Line	:	1421 W 47TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64112-1103
Country	:	US
Telephone Number	:	816-941-6226
Fax Number	:	816-941-6336

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN M HIEBERT
Credential	:	M.D.
Telephone Number	:	816-941-6226

Provider Enumeration Date	:	11/12/2010
Last Update Date	:	04/16/2014

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