Organization
MID AMERICA SENIOR MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNA MARIE MATHES (PRACTICE ADMINISTRATOR)
(913) 742-4084
Entity
Organization
Contact information
Practice address
21107 DONAHOO RD, TONGANOXIE, KS 66086-4153
(913) 742-4084
(913) 742-4086
Mailing address
PO BOX 996, TONGANOXIE, KS 66086-0996
(913) 742-4084
(913) 742-4086
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
04-21601
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100347530A
—
KS
Enumeration date
01/25/2007
Last updated
07/21/2011
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