Healthcare Provider Details

I. General information

NPI: 1801122361
Provider Name (Legal Business Name): MIDWEST DIGESTIVE HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 NE RALPH POWELL RD
LEES SUMMIT MO
64064-2357
US

IV. Provider business mailing address

3601 NE RALPH POWELL RD
LEES SUMMIT MO
64064-2357
US

V. Phone/Fax

Practice location:
  • Phone: 816-525-4440
  • Fax: 816-246-9887
Mailing address:
  • Phone: 816-525-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM G SOUTHWICK
Title or Position: PRES CEO
Credential:
Phone: 615-329-9212