Provider Demographics
NPI:1609500701
Name:RESTORE MEDICAL GROUP MIDWEST LLC
Entity type:Organization
Organization Name:RESTORE MEDICAL GROUP MIDWEST LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-558-7497
Mailing Address - Street 1:12021 E 13TH ST N STE 119
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2843
Mailing Address - Country:US
Mailing Address - Phone:316-330-5353
Mailing Address - Fax:316-330-5889
Practice Address - Street 1:12021 E 13TH ST N STE 119
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2843
Practice Address - Country:US
Practice Address - Phone:316-330-5353
Practice Address - Fax:316-330-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-13
Last Update Date:2024-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No251E00000XAgenciesHome Health
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health