Provider Demographics
NPI:1902050511
Name:MID AMERICA BALANCE INSTITUTE OF CASS COUNTY MISSOURI
Entity Type:Organization
Organization Name:MID AMERICA BALANCE INSTITUTE OF CASS COUNTY MISSOURI
Other - Org Name:MABI OF CASS COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:N
Authorized Official - Last Name:LAMPE
Authorized Official - Suffix:
Authorized Official - Credentials:PT PHD
Authorized Official - Phone:913-221-1148
Mailing Address - Street 1:17134 BEL RAY PL
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-5331
Mailing Address - Country:US
Mailing Address - Phone:816-246-1456
Mailing Address - Fax:816-286-2774
Practice Address - Street 1:17134 BEL RAY PL
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-5331
Practice Address - Country:US
Practice Address - Phone:816-246-1456
Practice Address - Fax:816-286-2774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1443Medicare PIN