Provider Demographics
NPI:1215088802
Name:MIDWEST SURGICAL ASSOCIATES, PA
Entity type:Organization
Organization Name:MIDWEST SURGICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:PENDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-782-8577
Mailing Address - Street 1:20375 W 151ST ST
Mailing Address - Street 2:SUITE 463
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7218
Mailing Address - Country:US
Mailing Address - Phone:913-782-8577
Mailing Address - Fax:913-782-2616
Practice Address - Street 1:20375 W 151ST ST
Practice Address - Street 2:SUITE 463
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7218
Practice Address - Country:US
Practice Address - Phone:913-782-8577
Practice Address - Fax:913-782-2616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100262960AMedicaid
09368018OtherBCBS OF KANSAS CITY
CC9224OtherRAILROAD MEDICARE
09368018OtherBCBS OF KANSAS CITY