MEDICARE: MID-WEST SURGICAL INCORPORATION

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

General Provider Information

NPI Number	:	1558019729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-WEST SURGICAL INCORPORATION

Provider Business Mailing Address
First Line	:	216 KINGSVILLE CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-2433
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 KINGSVILLE CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-2433
Country	:	US
Telephone Number	:	314-775-9446
Fax Number	:

Authorized Official
Title or Position	:	SALES REPRESENTATIVE
Name	:	SAMUEL BAKER
Credential	:
Telephone Number	:	314-775-9446

Provider Enumeration Date	:	03/16/2022
Last Update Date	:	03/16/2022

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