Provider Demographics
NPI:1619201050
Name:MID-AMERICA ORTHOPEDICS LLC
Entity Type:Organization
Organization Name:MID-AMERICA ORTHOPEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-262-4886
Mailing Address - Street 1:1923 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3405
Mailing Address - Country:US
Mailing Address - Phone:316-630-9300
Mailing Address - Fax:316-858-3201
Practice Address - Street 1:701 W CENTRAL AVE # 101
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2117
Practice Address - Country:US
Practice Address - Phone:316-321-2663
Practice Address - Fax:316-321-1194
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID-AMERICA ORTHOPEDICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-01
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6334460001Medicare NSC