Healthcare Provider Details

I. General information

NPI: 1306357801
Provider Name (Legal Business Name): MIDWAY SURGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 N CUMBERLAND AVE
CHICAGO IL
60656-4239
US

IV. Provider business mailing address

6339 E SPEEDWAY BLVD
TUCSON AZ
85710-1147
US

V. Phone/Fax

Practice location:
  • Phone: 520-323-8732
  • Fax:
Mailing address:
  • Phone: 520-323-8732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AUTUMN ROMO
Title or Position: LEAD PATIENT ADVOCATE
Credential:
Phone: 520-258-0307