MEDICARE: MIDWAY HEALTH

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	332B00000X	Durable Medical Equipment & Medical Supplies	44657	CA

General Provider Information

NPI Number	:	1295753119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWAY HEALTH

Provider Business Mailing Address
First Line	:	8616 LA TIJERA BLVD STE 305
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3946
Country	:	US
Telephone Number	:	310-417-3536
Fax Number	:

Provider Business Practice Location Address
First Line	:	8616 LA TIJERA BLVD STE 305
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3946
Country	:	US
Telephone Number	:	310-417-3536
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ MANAGING EMPLOYEE
Name	:	GENRIETA ALEXANDREA LANGE
Credential	:
Telephone Number	:	310-417-3536

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	08/22/2020

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Directions to “MIDWAY HEALTH ” Practice Location

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