MEDICARE: MIDWAY FAMILY SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1043028608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWAY FAMILY SERVICES LLC

Provider Business Mailing Address
First Line	:	2933 VIRGINIA AVE S
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55426-3035
Country	:	US
Telephone Number	:	612-242-4132
Fax Number	:

Provider Business Practice Location Address
First Line	:	2933 VIRGINIA AVE S
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55426-3035
Country	:	US
Telephone Number	:	612-242-4132
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ADAM MAYER
Credential	:	LPCC
Telephone Number	:	651-208-1094

Provider Enumeration Date	:	12/27/2024
Last Update Date	:	12/27/2024

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Directions to “MIDWAY FAMILY SERVICES LLC ” Practice Location

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