Provider Demographics
NPI:1083794747
Name:MID-AMERICA RETINA CONSULTANTS PA
Entity Type:Organization
Organization Name:MID-AMERICA RETINA CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-663-5900
Mailing Address - Street 1:PO BOX 843330
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184
Mailing Address - Country:US
Mailing Address - Phone:913-663-5900
Mailing Address - Fax:913-663-5902
Practice Address - Street 1:10740 NALL AVENUE
Practice Address - Street 2:SUITE 220
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211
Practice Address - Country:US
Practice Address - Phone:913-663-5900
Practice Address - Fax:913-663-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36399174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSCH1626OtherRAILROAD MEDICARE PIN
KSCH1625OtherRAILROAD MEDICARE PIN
MOCH1627OtherRAILROAD MEDICARE PIN
KS110053Medicare PIN
MO1440000Medicare PIN
KSCH1625OtherRAILROAD MEDICARE PIN