Provider Demographics
NPI:1366817744
Name:MID-AMERICA TRANSPLANT SERVICES
Entity Type:Organization
Organization Name:MID-AMERICA TRANSPLANT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:BROCKMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-735-8267
Mailing Address - Street 1:1110 HIGHLANDS PLAZA DR E
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1350
Mailing Address - Country:US
Mailing Address - Phone:314-735-8274
Mailing Address - Fax:
Practice Address - Street 1:1110 HIGHLANDS PLAZA DR E
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1350
Practice Address - Country:US
Practice Address - Phone:314-735-8274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical