| Mid-america Sports Medicine and Wellness | |
|
19550 E 39th St S Suite 419 Independence MO 64057-2303 | |
| (816) 795-8200 | |
| (816) 795-7735 |
| Full Name | Mid-america Sports Medicine and Wellness |
|---|---|
| Speciality | Family Medicine - Sports Medicine |
| Location | 19550 E 39th St S, Independence, Missouri |
| Authorized Official Name and Position | Patrick J Kueny (VICE PRESIDENT) |
| Authorized Official Contact | 8165084090 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mid-america Sports Medicine and Wellness 19550 E 39th St S Suite 419 Independence MO 64057-2303 Ph: (816) 795-8200 | Mid-america Sports Medicine and Wellness 19550 E 39th St S Suite 419 Independence MO 64057-2303 Ph: (816) 795-8200 |
| NPI Number | 1841462314 |
|---|---|
| Provider Enumeration Date | 03/25/2008 |
| Last Update Date | 12/16/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841462314 | NPI | - | NPPES |
| 200584160 B | Medicaid | KS | |
| 200584160 A | Medicaid | KS | |
| 1841462314 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | () | Primary |
| 208M00000X | Hospitalist | () | Secondary |
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