Provider Demographics
NPI:1376691444
Name:MID-AMERICA UROLOGY, PA
Entity Type:Organization
Organization Name:MID-AMERICA UROLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CONNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-780-3388
Mailing Address - Street 1:20375 W 151ST ST
Mailing Address - Street 2:STE 270
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5306
Mailing Address - Country:US
Mailing Address - Phone:913-780-3388
Mailing Address - Fax:913-780-3256
Practice Address - Street 1:705 BAPTISTE DR
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1336
Practice Address - Country:US
Practice Address - Phone:913-780-3388
Practice Address - Fax:913-780-3256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100153430BMedicaid
CS3061OtherRAILROAD MEDICARE
KS110499Medicare PIN
KS100153430BMedicaid