Provider Demographics
NPI:1164045126
Name:MID-AMERICA ORTHOPEDICS KC LLC
Entity Type:Organization
Organization Name:MID-AMERICA ORTHOPEDICS KC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-232-9846
Mailing Address - Street 1:7820 W 165TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2925
Mailing Address - Country:US
Mailing Address - Phone:913-232-9846
Mailing Address - Fax:913-232-9817
Practice Address - Street 1:7820 W 165TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2925
Practice Address - Country:US
Practice Address - Phone:913-232-9846
Practice Address - Fax:913-232-9817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies