Healthcare Provider Details

I. General information

NPI: 1295286045
Provider Name (Legal Business Name): MIDWEST MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N MAIN ST
ELIZABETH IL
61028-8800
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
GALENA IL
61036-8118
US

V. Phone/Fax

Practice location:
  • Phone: 815-858-2238
  • Fax: 815-858-2239
Mailing address:
  • Phone: 815-777-1340
  • Fax: 815-777-2560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRACY L BAUER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 815-777-1340