Provider Demographics
NPI:1699823310
Name:MID-AMERICA UROLOGY, PA
Entity Type:Organization
Organization Name:MID-AMERICA UROLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:B
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-948-8365
Mailing Address - Street 1:10550 QUIVIRA RD
Mailing Address - Street 2:STE 270
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2306
Mailing Address - Country:US
Mailing Address - Phone:913-948-8365
Mailing Address - Fax:913-541-1034
Practice Address - Street 1:1000 CARONDELET DR
Practice Address - Street 2:ST JOSEPH MEDICAL CENTER
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4673
Practice Address - Country:US
Practice Address - Phone:816-942-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO501412308Medicaid
CS3061OtherRAILROAD MEDICARE
KS100363600AMedicaid
MO501412308Medicaid
CS3061OtherRAILROAD MEDICARE