MEDICARE: MIDWEST HEALTH GROUP CONVENIENT CARE

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	:	1578797031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST HEALTH GROUP CONVENIENT CARE

Provider Business Mailing Address
First Line	:	550 MAPLE VALLEY DR
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1981
Country	:	US
Telephone Number	:	573-454-2466
Fax Number	:	573-454-2544

Provider Business Practice Location Address
First Line	:	550 MAPLE VALLEY DR
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1981
Country	:	US
Telephone Number	:	573-454-2466
Fax Number	:	573-454-2544

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. PAUL MONIZ
Credential	:	M.D.
Telephone Number	:	573-454-2466

Provider Enumeration Date	:	05/12/2009
Last Update Date	:	01/12/2016

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