Healthcare Provider Details

I. General information

NPI: 1568895134
Provider Name (Legal Business Name): MIDWEST ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2013
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4229 FREDERICK AVE STE B STE B
SAINT JOSEPH MO
64506-3159
US

IV. Provider business mailing address

9 FIELDCREST LN
SAINT JOSEPH MO
64506-1727
US

V. Phone/Fax

Practice location:
  • Phone: 816-262-6210
  • Fax:
Mailing address:
  • Phone: 816-262-6210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KENNETH W SHEWELL
Title or Position: SECRETARY / TREASURER
Credential: MD
Phone: 816-262-6210