| Mid America Senior Management Aco Llc | |
|
21107 Donahoo Rd Tonganoxie KS 66086-4153 | |
| (913) 742-4084 | |
| Not Available |
| Full Name | Mid America Senior Management Aco Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 21107 Donahoo Rd, Tonganoxie, Kansas |
| Authorized Official Name and Position | Mark Petersen (OWNER) |
| Authorized Official Contact | 9132086221 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mid America Senior Management Aco Llc 21107 Donahoo Rd Tonganoxie KS 66086-4153 Ph: (913) 742-4084 | Mid America Senior Management Aco Llc 21107 Donahoo Rd Tonganoxie KS 66086-4153 Ph: (913) 742-4084 |
| NPI Number | 1326888900 |
|---|---|
| Provider Enumeration Date | 05/30/2024 |
| Last Update Date | 05/30/2024 |
| Medicare PECOS PAC ID | 1456896190 |
|---|---|
| Medicare Enrollment ID | O20240717002639 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326888900 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Mark I Petersen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881647543 PECOS PAC ID: 9133190168 Enrollment ID: I20120303000026 |
| Provider Name | Tracy S Alagna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790060705 PECOS PAC ID: 0446480933 Enrollment ID: I20140228001811 |
| Provider Name | Nana Amma Asante |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932705647 PECOS PAC ID: 2860891140 Enrollment ID: I20210519002161 |
Unified School District No. 464 Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 330 East 24/40 Hwy, Tonganoxie, KS 66086 Phone: 913-369-2183 Fax: 913-845-3629 | |
Tonganoxie Family Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 508 E 4th St, Tonganoxie, KS 66086 Phone: 913-369-2353 Fax: 913-845-2258 | |
Mid America Senior Management Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 21107 Donahoo Rd, Tonganoxie, KS 66086 Phone: 913-742-4084 Fax: 913-742-4086 |