MEDICARE: MIDWEST UROLOGY CENTER, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA4695001	OTHER		MEDICARE PROVIDER PTAN
2	MA4695	OTHER		MEDICARE GROUP PTAN

General Provider Information

NPI Number	:	1962834390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST UROLOGY CENTER, PC

Provider Business Mailing Address
First Line	:	PO BOX 2220
Second Line	:
City	:	JOPLIN
State	:	MO
Zip	:	64803-2220
Country	:	US
Telephone Number	:	417-781-7220
Fax Number	:	417-781-5512

Provider Business Practice Location Address
First Line	:	1905 W 32ND ST STE 302
Second Line	:
City	:	JOPLIN
State	:	MO
Zip	:	64804-1512
Country	:	US
Telephone Number	:	417-781-7220
Fax Number	:	417-781-5512

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	ROGER H SCHOENFELD
Credential	:	DO
Telephone Number	:	417-781-7220

Provider Enumeration Date	:	08/08/2013
Last Update Date	:	01/08/2014

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Directions to “MIDWEST UROLOGY CENTER, PC ” Practice Location

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