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General NPI Number Information
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NPI Number | 1487601506
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Entity Type | Organization
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Legal Business Name | MIDWEST EMERGENCY MANAGEMENT, INC.
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 03/15/2018
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Provider Practice Location Address
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Address Line | 1512 N GREEN MOUNT RD
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City | O FALLON
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State | IL
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Zip | 62269-1953
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Country | US
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Telephone | 618-624-3750
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 797069
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City | ST. LOUIS
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State | MO
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Zip | 63179-7000
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Country | US
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Telephone | 888-577-6337
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Fax | 618-624-3387
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Authorized Official
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Title or Position | PRESIDENT/CMO
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Name | MR. CARMON L. GLOVER III
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Credential | DO
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Telephone | 888-577-6337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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