MEDICARE: MID STAR LAB INC

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
2	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1831578368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID STAR LAB INC

Provider Business Mailing Address
First Line	:	1701 COMMERCE RD
Second Line	:
City	:	TONGANOXIE
State	:	KS
Zip	:	66086-5369
Country	:	US
Telephone Number	:	913-369-8734
Fax Number	:	913-369-2886

Provider Business Practice Location Address
First Line	:	5205 E KELLOGG DR STE 101
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67218-1634
Country	:	US
Telephone Number	:	913-369-8734
Fax Number	:	913-369-2886

Authorized Official
Title or Position	:	CEO
Name	:	KARI WAGNER
Credential	:	CPED
Telephone Number	:	913-369-8734

Provider Enumeration Date	:	05/29/2015
Last Update Date	:	02/04/2026

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