Provider Demographics
NPI:1851457469
Name:MIDAMERICA ALLIANCE FOR ACCESS CORPORATION
Entity Type:Organization
Organization Name:MIDAMERICA ALLIANCE FOR ACCESS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS (GARRETT)
Authorized Official - Middle Name:GARRETT
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-321-5140
Mailing Address - Street 1:311 DELAWARE ST.
Mailing Address - Street 2:#102 #A
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105
Mailing Address - Country:US
Mailing Address - Phone:913-321-5140
Mailing Address - Fax:913-321-5140
Practice Address - Street 1:311 DELAWARE ST.
Practice Address - Street 2:#102 #A
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64105
Practice Address - Country:US
Practice Address - Phone:913-321-5140
Practice Address - Fax:913-321-5140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003018091235Z00000X
MO01247235Z00000X
251B00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100033910AMedicaid
MO266257104Medicaid
MO504580002Medicaid