MEDICARE: MIDWAY FAMILY CLINIC PA

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1114988805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWAY FAMILY CLINIC PA

Provider Business Mailing Address
First Line	:	1821 UNIVERSITY AVE W
Second Line	:	SUITE S-206
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-2801
Country	:	US
Telephone Number	:	651-644-2273
Fax Number	:	651-659-2273

Provider Business Practice Location Address
First Line	:	1821 UNIVERSITY AVE W
Second Line	:	SUITE S-206
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-2801
Country	:	US
Telephone Number	:	651-644-2273
Fax Number	:	651-659-2273

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YOHANNES GEBRE
Credential	:
Telephone Number	:	651-644-2273

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	08/22/2020

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Directions to “MIDWAY FAMILY CLINIC PA ” Practice Location

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