Provider Demographics
NPI:1699911677
Name:MIDWEST ONCOLOGY ASSOCIATES LLC
Entity type:Organization
Organization Name:MIDWEST ONCOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-498-6773
Mailing Address - Street 1:2316 E MEYER BLVD
Mailing Address - Street 2:1 CANCER WEST
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-1136
Mailing Address - Country:US
Mailing Address - Phone:816-276-4700
Mailing Address - Fax:816-276-3810
Practice Address - Street 1:2316 E MEYER BLVD
Practice Address - Street 2:1 CANCER WEST
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1136
Practice Address - Country:US
Practice Address - Phone:816-276-4700
Practice Address - Fax:816-276-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1699911677Medicaid
KS200603210BMedicaid
KS200603210AMedicaid
KS200603210BMedicaid
KS200603210AMedicaid
MO1699911677Medicaid
MOMA1794Medicare PIN