Healthcare Provider Details

I. General information

NPI: 1588108716
Provider Name (Legal Business Name): MIDWEST FIRST ASSISTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9464 ERIKA LN
NEW BLOOMFIELD MO
65063-1942
US

IV. Provider business mailing address

9464 ERIKA LN
NEW BLOOMFIELD MO
65063-1942
US

V. Phone/Fax

Practice location:
  • Phone: 573-230-6820
  • Fax:
Mailing address:
  • Phone: 573-230-6820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number2004020033
License Number StateMO

VIII. Authorized Official

Name: MR. DAVID F THOMAS JR.
Title or Position: OWNER/RNFA
Credential: RN
Phone: 573-230-6820