Provider Demographics
NPI:1538106448
Name:MIDWEST HEMORRHOID TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:MIDWEST HEMORRHOID TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOULTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:913-541-0600
Mailing Address - Street 1:11111 NALL AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1620
Mailing Address - Country:US
Mailing Address - Phone:913-451-0600
Mailing Address - Fax:913-451-0601
Practice Address - Street 1:11111 NALL AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1620
Practice Address - Country:US
Practice Address - Phone:913-451-0600
Practice Address - Fax:913-451-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-30033174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSH86476Medicare UPIN