Provider Demographics
NPI:1477626547
Name:MID-AMERICA PHYSICIANS, CHTD.
Entity Type:Organization
Organization Name:MID-AMERICA PHYSICIANS, CHTD.
Other - Org Name:DESOTO FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:RETTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-422-2020
Mailing Address - Street 1:6815 HILLTOP RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-3532
Mailing Address - Country:US
Mailing Address - Phone:913-422-2020
Mailing Address - Fax:913-441-6847
Practice Address - Street 1:6815 HILLTOP RD
Practice Address - Street 2:STE. 100
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-3532
Practice Address - Country:US
Practice Address - Phone:913-422-2020
Practice Address - Fax:913-441-6847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSC480000Medicare ID - Type Unspecified