Provider Demographics
NPI:1366625493
Name:MIDWEST OBGYN, PA
Entity Type:Organization
Organization Name:MIDWEST OBGYN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-829-5656
Mailing Address - Street 1:20375 W 151ST ST
Mailing Address - Street 2:SUITE 409
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5350
Mailing Address - Country:US
Mailing Address - Phone:913-829-5656
Mailing Address - Fax:913-829-1513
Practice Address - Street 1:20375 W 151ST ST
Practice Address - Street 2:SUITE 409
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5350
Practice Address - Country:US
Practice Address - Phone:913-829-5656
Practice Address - Fax:913-829-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0420341207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSE18468Medicare UPIN
KSJ681574Medicare PIN