Healthcare Provider Details

I. General information

NPI: 1306028774
Provider Name (Legal Business Name): MIDWEST CONSULTING AND IME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 04/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 S NEW BALLAS RD SUITE 230
CREVE COEUR MO
63141-8704
US

IV. Provider business mailing address

16412 GREEN PINES DR
WILDWOOD MO
63011-1850
US

V. Phone/Fax

Practice location:
  • Phone: 314-681-2800
  • Fax: 314-432-5088
Mailing address:
  • Phone: 314-378-6071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberCEO5286
License Number StateMO

VIII. Authorized Official

Name: DR. SCOTT F HAINZ
Title or Position: PRESIDENT/OWNER
Credential: DC
Phone: 314-378-6071