Provider Demographics
NPI:1568422152
Name:MID CONTINENT ORTHOPEDICS, P.A.
Entity Type:Organization
Organization Name:MID CONTINENT ORTHOPEDICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ESTIVO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:316-946-0096
Mailing Address - Street 1:PO BOX 12368
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67277-2368
Mailing Address - Country:US
Mailing Address - Phone:316-946-0096
Mailing Address - Fax:316-946-9920
Practice Address - Street 1:6634 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3315
Practice Address - Country:US
Practice Address - Phone:316-946-0096
Practice Address - Fax:316-946-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-25156207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100235100CMedicaid
KS100235100CMedicaid
KS4097220001Medicare NSC