Healthcare Provider Details

I. General information

NPI: 1184644981
Provider Name (Legal Business Name): MIDWEST MEDICAL HEALTHCARE, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 W LINCOLN ST STE 560
BELLEVILLE IL
62220-1900
US

IV. Provider business mailing address

340 W LINCOLN ST STE 560
BELLEVILLE IL
62220-1900
US

V. Phone/Fax

Practice location:
  • Phone: 618-355-7745
  • Fax: 161-835-5759
Mailing address:
  • Phone: 618-355-7745
  • Fax: 161-835-5759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number131902
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number100358
License Number StateMO

VIII. Authorized Official

Name: JOHN A. HUCKER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 618-355-7745