Provider Demographics
NPI:1083652473
Name:MID-KANSAS ANESTHESIA PA
Entity Type:Organization
Organization Name:MID-KANSAS ANESTHESIA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:DARGER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:620-825-4347
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:KIOWA
Mailing Address - State:KS
Mailing Address - Zip Code:67070-0235
Mailing Address - Country:US
Mailing Address - Phone:620-825-4347
Mailing Address - Fax:620-825-4347
Practice Address - Street 1:603 N 9TH ST
Practice Address - Street 2:
Practice Address - City:KIOWA
Practice Address - State:KS
Practice Address - Zip Code:67070-1009
Practice Address - Country:US
Practice Address - Phone:620-825-4347
Practice Address - Fax:620-825-4347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-58608-061367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS044368OtherBLUE CROSS/BLUE SHIELD
=========001OtherBLUE CROSS/BLUE SHIELD