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General NPI Number Information
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NPI Number | 1689739666
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Entity Type | Organization
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Legal Business Name | MID-WEST PODIATRY & ASSOCIATES, L L C
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 11/14/2016
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Provider Practice Location Address
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Address Line | 500 W PINE ST
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City | FARMINGTON
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State | MO
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Zip | 63640-1426
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Country | US
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Telephone | 573-756-8986
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Fax | 573-756-0419
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Provider Business Mailing Address
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Address Line | 500 W PINE ST
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City | FARMINGTON
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State | MO
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Zip | 63640-1426
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Country | US
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Telephone | 573-756-8986
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Fax | 573-756-0419
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | HIEU NGUYEN
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Credential |
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Telephone | 314-432-1903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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