Healthcare Provider Details

I. General information

NPI: 1487601506
Provider Name (Legal Business Name): MIDWEST EMERGENCY MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 N GREEN MOUNT RD
O FALLON IL
62269-1953
US

IV. Provider business mailing address

PO BOX 797069
ST. LOUIS MO
63179-7000
US

V. Phone/Fax

Practice location:
  • Phone: 618-624-3750
  • Fax:
Mailing address:
  • Phone: 888-577-6337
  • Fax: 618-624-3387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CARMON L. GLOVER III
Title or Position: PRESIDENT/CMO
Credential: DO
Phone: 888-577-6337