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General NPI Number Information
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NPI Number | 1649468786
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Entity Type | Organization
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Legal Business Name | MIDWEST CARDIOVASCULAR, INC.
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 1031 BELLEVUE AVE STE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1856
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Country | US
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Telephone | 314-644-5650
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Fax | 314-644-1524
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Provider Business Mailing Address
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Address Line | 1031 BELLEVUE AVE STE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1856
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Country | US
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Telephone | 314-644-5650
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Fax | 314-644-1524
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Authorized Official
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Title or Position | RN/OFFICE MANAGER
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Name | MS. NANCY BODET
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Credential | RN
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Telephone | 314-644-5650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | R1E18
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License Number State | MO
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