Provider Demographics
NPI:1356498927
Name:MID AMERICA CARDIAC CONSULTANTS P.A.
Entity Type:Organization
Organization Name:MID AMERICA CARDIAC CONSULTANTS P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:MELEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-688-0321
Mailing Address - Street 1:1431 BLUFFVIEW ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-3039
Mailing Address - Country:US
Mailing Address - Phone:316-688-0321
Mailing Address - Fax:316-688-0728
Practice Address - Street 1:1431 BLUFFVIEW ST
Practice Address - Street 2:SUITE 112
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3039
Practice Address - Country:US
Practice Address - Phone:316-688-0321
Practice Address - Fax:316-688-0728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS003961OtherBCBS PROVER
KS003961OtherBCBS PROVER
KS=========OtherTAX ID