Provider Demographics
NPI:1366680969
Name:MID-KANSAS HEART CENTER, P.A.
Entity Type:Organization
Organization Name:MID-KANSAS HEART CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:316-263-5889
Mailing Address - Street 1:PO BOX 2178
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-2178
Mailing Address - Country:US
Mailing Address - Phone:316-263-5889
Mailing Address - Fax:316-267-3601
Practice Address - Street 1:1515 S CLIFTON AVE STE 320
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2953
Practice Address - Country:US
Practice Address - Phone:316-263-5889
Practice Address - Fax:316-267-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-25651207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100236410EMedicaid
KSKA2075OtherBLUE CROSS
KSKA2075Medicare PIN
KS100236410EMedicaid