Organization
MID AMERICA NEUROSPINE LLC
Active
Other names
E Jerome Hanson MD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERNEST JEROME HANSON M.D. (OWNER/PHYSICIAN)
(913) 851-2919
Entity
Organization
Contact information
Practice address
5701 W 119TH ST, SUITE 331, OVERLAND PARK, KS 66209-3721
(913) 851-2919
Mailing address
15438 IRON HORSE CIR, LEAWOOD, KS 66224-3852
(913) 851-2919
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
04-16128
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02119079
BCBS
—
01
—
060060027
MEDICARE RAILROAD #
—
01
—
27321011
GROUP BCBS#
—
01
—
P163279
MEDICARE INDIVIDUAL P163279
KS
Enumeration date
06/05/2008
Last updated
11/18/2008
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