Healthcare Provider Details

I. General information

NPI: 1508993379
Provider Name (Legal Business Name): MIDWEST CARDIOVASCULAR ULTRASOUND SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 06/15/2021
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S CAMPBELL AVE STE J
SPRINGFIELD MO
65807-2000
US

IV. Provider business mailing address

1700 S CAMPBELL AVE STE J
SPRINGFIELD MO
65807-2000
US

V. Phone/Fax

Practice location:
  • Phone: 417-719-4026
  • Fax: 833-792-4156
Mailing address:
  • Phone: 417-209-5700
  • Fax: 833-792-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KEVIN SCOTT
Title or Position: OWNER
Credential:
Phone: 417-209-5700