Provider Demographics
NPI:1710948906
Name:MID AMERICA SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:MID AMERICA SURGICAL ASSOCIATES
Other - Org Name:KANSAS VEIN CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:COO CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-616-6272
Mailing Address - Street 1:9350 E 35TH ST N
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2019
Mailing Address - Country:US
Mailing Address - Phone:316-616-6272
Mailing Address - Fax:316-616-0407
Practice Address - Street 1:9350 E 35TH ST N
Practice Address - Street 2:SUITE 104
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2019
Practice Address - Country:US
Practice Address - Phone:316-616-6272
Practice Address - Fax:316-616-0407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Not Answered208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110748Medicare ID - Type Unspecified