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General NPI Number Information
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NPI Number | 1366000580
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Entity Type | Organization
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Legal Business Name | MIDWEST/EDGERTON MEDICAL SERVICES, INC.
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Dates
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Enumeration Date | 06/03/2019
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Last Update Date | 06/03/2019
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Provider Practice Location Address
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Address Line | 531 PEAKE ST.
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City | MIDWEST
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State | WY
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Zip | 82643
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Country | US
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Telephone | 307-315-4173
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Fax | 307-437-6514
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Provider Business Mailing Address
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Address Line | PO BOX 356
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City | MIDWEST
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State | WY
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Zip | 82643-0356
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Country | US
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Telephone | 307-315-4173
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Fax | 307-437-6514
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MICHAEL RAY SMITH
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Credential |
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Telephone | 307-315-4173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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