Provider Demographics
NPI:1437509320
Name:MID-AMERICA CRITICAL CARE
Entity Type:Organization
Organization Name:MID-AMERICA CRITICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:SALGADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-634-1795
Mailing Address - Street 1:241 N HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4903
Mailing Address - Country:US
Mailing Address - Phone:316-776-9495
Mailing Address - Fax:316-616-2095
Practice Address - Street 1:550 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4910
Practice Address - Country:US
Practice Address - Phone:316-962-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0426218207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100298080CMedicaid
KS100298080CMedicaid
KS1760484323Medicare NSC
11395086OtherCAQH