MEDICARE: MIDWEST EXPRESS CARE 4 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1356188213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST EXPRESS CARE 4 LLC

Provider Business Mailing Address
First Line	:	PO BOX 775342
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-5342
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1225 E RIDGE RD
Second Line	:
City	:	GRIFFITH
State	:	IN
Zip	:	46319-1461
Country	:	US
Telephone Number	:	219-934-7515
Fax Number	:	219-228-7226

Authorized Official
Title or Position	:	CC SPECIALIST LEAD
Name	:	JENNIFER BATY
Credential	:
Telephone Number	:	605-789-6574

Provider Enumeration Date	:	07/09/2024
Last Update Date	:	07/09/2024

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Directions to “MIDWEST EXPRESS CARE 4 LLC ” Practice Location

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