Healthcare Provider Details

I. General information

NPI: 1922266212
Provider Name (Legal Business Name): MIDWEST MEDICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7331 WATSON RD
SAINT LOUIS MO
63119-4405
US

IV. Provider business mailing address

7345 WATSON RD
SAINT LOUIS MO
63119-4405
US

V. Phone/Fax

Practice location:
  • Phone: 314-752-7100
  • Fax: 314-752-3256
Mailing address:
  • Phone: 314-752-7100
  • Fax: 314-752-3256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateMO

VIII. Authorized Official

Name: M ROBERT HILL
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 314-633-8641