Provider Demographics
NPI:1063701985
Name:MIDWIVES OF KANSAS CITY, LLC
Entity type:Organization
Organization Name:MIDWIVES OF KANSAS CITY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:913-547-1495
Mailing Address - Street 1:6115 NIEMAN RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66203-2939
Mailing Address - Country:US
Mailing Address - Phone:877-551-0001
Mailing Address - Fax:
Practice Address - Street 1:6115 NIEMAN RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66203-2939
Practice Address - Country:US
Practice Address - Phone:877-551-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
KS0068275-001261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0068275-001OtherKANSAS PERMIT FOR OPERATION OF FREE STANDING BIRTH CENTER