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General NPI Number Information
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NPI Number | 1134607369
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Entity Type | Organization
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Legal Business Name | MIDWEST INNOVATIVE HEALTH INC
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 08/08/2018
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Provider Practice Location Address
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Address Line | 409 SE DOUGLAS ST
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City | LEES SUMMIT
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State | MO
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Zip | 64063
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Country | US
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Telephone | 816-578-4548
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Fax | 816-774-8132
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Provider Business Mailing Address
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Address Line | 99 Z ST
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City | LAKE LOTAWANA
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State | MO
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Zip | 64086-9769
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Country | US
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Telephone | 816-578-4548
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Fax | 816-774-8132
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Authorized Official
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Title or Position | MANAGER
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Name | STACEY M DEISTER
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Credential |
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Telephone | 816-365-4070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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