Healthcare Provider Details

I. General information

NPI: 1194776815
Provider Name (Legal Business Name): MIDWEST MEDICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 S LINDBERGH BLVD
SAINT LOUIS MO
63127-1356
US

IV. Provider business mailing address

3825 S LINDBERGH BLVD
SAINT LOUIS MO
63127-1356
US

V. Phone/Fax

Practice location:
  • Phone: 317-821-7227
  • Fax: 314-821-2552
Mailing address:
  • Phone: 317-821-7227
  • Fax: 314-821-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMMY HAMMA
Title or Position: IMAGING SERVICES DIRECTOR
Credential:
Phone: 314-821-7227