Provider Demographics
NPI:1740309202
Name:MID AMERICA KIDNEY STONE ASSOCIATION
Entity type:Organization
Organization Name:MID AMERICA KIDNEY STONE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:WORTHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-703-7335
Mailing Address - Street 1:10983 GRANADA LN STE 110
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1401
Mailing Address - Country:US
Mailing Address - Phone:913-766-1860
Mailing Address - Fax:913-232-9336
Practice Address - Street 1:10983 GRANADA LN STE 110
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1401
Practice Address - Country:US
Practice Address - Phone:913-766-1860
Practice Address - Fax:913-232-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy