Healthcare Provider Details

I. General information

NPI: 1356188213
Provider Name (Legal Business Name): MIDWEST EXPRESS CARE 4 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 E RIDGE RD
GRIFFITH IN
46319-1461
US

IV. Provider business mailing address

PO BOX 775342
CHICAGO IL
60677-5342
US

V. Phone/Fax

Practice location:
  • Phone: 219-934-7515
  • Fax: 219-228-7226
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BATY
Title or Position: CC SPECIALIST LEAD
Credential:
Phone: 605-789-6574