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General NPI Number Information
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NPI Number | 1679814305
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Entity Type | Organization
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Legal Business Name | MIDWEST MEDICAL AND OCCUPATIONAL SERVICES SC
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 03/11/2013
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Provider Practice Location Address
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Address Line | 1104 S 42ND ST
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City | MOUNT VERNON
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State | IL
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Zip | 62864-6216
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Country | US
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Telephone | 618-315-6575
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Fax |
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Provider Business Mailing Address
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Address Line | 1104 S 42ND ST
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City | MOUNT VERNON
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State | IL
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Zip | 62864-6216
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Country | US
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Telephone | 618-315-6575
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Fax |
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Authorized Official
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Title or Position | SHAREHOLDER/DIRECTOR
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Name | CHRISTIE LYNN FOSTER
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Credential | MD
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Telephone | 618-315-6575
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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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