Healthcare Provider Details

I. General information

NPI: 1942232269
Provider Name (Legal Business Name): MIDWEST INTERNAL MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 MC CLELLAND BLVD STE 252
JOPLIN MO
64804-1647
US

IV. Provider business mailing address

2817 MC CLELLAND BLVD STE 252
JOPLIN MO
64804-1647
US

V. Phone/Fax

Practice location:
  • Phone: 417-626-8200
  • Fax: 417-626-8809
Mailing address:
  • Phone: 417-626-8200
  • Fax: 417-626-8809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberR1F87
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR7E45
License Number StateMO

VIII. Authorized Official

Name: DR. JACK V RHOADS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 417-626-8200