Healthcare Provider Details

I. General information

NPI: 1407572175
Provider Name (Legal Business Name): MIDWEST FAMILY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 UNION RD SUITE 100
SAINT LOUIS MO
63125
US

IV. Provider business mailing address

65 DOCTORS PARK STE A
CAPE GIRARDEAU MO
63703-4927
US

V. Phone/Fax

Practice location:
  • Phone: 314-626-3602
  • Fax: 573-651-8734
Mailing address:
  • Phone: 573-651-1687
  • Fax: 573-651-8734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBORAH SEEGER
Title or Position: OWNER
Credential: NP-C
Phone: 573-651-1687