Provider Demographics
NPI:1770768012
Name:MIDWEST RADIOLOGY INSTITUTE
Entity type:Organization
Organization Name:MIDWEST RADIOLOGY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIPP
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAN CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:913-745-5300
Mailing Address - Street 1:6800 HILLTOP RD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226
Mailing Address - Country:US
Mailing Address - Phone:913-745-5300
Mailing Address - Fax:913-745-5530
Practice Address - Street 1:1230 SW HARVEY ST
Practice Address - Street 2:SUITE B
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-4069
Practice Address - Country:US
Practice Address - Phone:785-783-8559
Practice Address - Fax:785-783-8562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-06
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05253112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSDH1928OtherRR MEDICARE
KS111397OtherBCBS
KS100234960JMedicaid
KSDH1928OtherRR MEDICARE
KS111397OtherBCBS