Provider Demographics
NPI:1154656759
Name:MIDWEST ORTHOPEDIC RESOURSES, LLC
Entity Type:Organization
Organization Name:MIDWEST ORTHOPEDIC RESOURSES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-617-9625
Mailing Address - Street 1:1624 N CLARENCE AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-1522
Mailing Address - Country:US
Mailing Address - Phone:316-617-9625
Mailing Address - Fax:316-260-3659
Practice Address - Street 1:1624 N CLARENCE AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-1522
Practice Address - Country:US
Practice Address - Phone:316-617-9625
Practice Address - Fax:316-260-3659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies