Provider Demographics
NPI:1346626298
Name:MID STAR ORTHOPEDIC PRODUCTS, INC.
Entity Type:Organization
Organization Name:MID STAR ORTHOPEDIC PRODUCTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:
Authorized Official - First Name:CANDIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:913-369-8734
Mailing Address - Street 1:10935 KAW DRIVE
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66111
Mailing Address - Country:US
Mailing Address - Phone:913-369-8734
Mailing Address - Fax:913-369-2886
Practice Address - Street 1:10935 KAW DRIVE
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66111
Practice Address - Country:US
Practice Address - Phone:913-369-8734
Practice Address - Fax:913-369-2886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies