Healthcare Provider Details

I. General information

NPI: 1245535459
Provider Name (Legal Business Name): MIDWEST ACUTE CARE CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6698 KEATON CORPORATE PKWY STE 101
O FALLON MO
63368-8727
US

IV. Provider business mailing address

11155 DUNN RD STE 315E
SAINT LOUIS MO
63136-6185
US

V. Phone/Fax

Practice location:
  • Phone: 636-928-0215
  • Fax: 636-928-0218
Mailing address:
  • Phone: 314-355-7500
  • Fax: 314-355-3287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number113413
License Number StateMO

VIII. Authorized Official

Name: NAT T LEVY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 314-355-7500