Provider Demographics
NPI:1679529754
Name:MIDWEST UROLOGY & RADIATION ONCOLOGY, INC, PC.
Entity type:Organization
Organization Name:MIDWEST UROLOGY & RADIATION ONCOLOGY, INC, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-836-6875
Mailing Address - Street 1:17525 MEDICAL CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-1824
Mailing Address - Country:US
Mailing Address - Phone:816-836-6875
Mailing Address - Fax:816-214-9009
Practice Address - Street 1:19001 E 48TH ST S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6964
Practice Address - Country:US
Practice Address - Phone:816-836-8831
Practice Address - Fax:816-795-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5190000AMedicare PIN
TX00761XMedicare PIN