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NPI Code Detail

MEDICARE: MIDWEST CARDIOVASCULAR, INC.

MEDICARE: MIDWEST CARDIOVASCULAR, INC.
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
1207RC0000XCardiovascular Disease PhysicianR1E18MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11649468786OTHERMONPI

General Provider Information

NPI Number : 1649468786
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDWEST CARDIOVASCULAR, INC.
Provider Business Mailing Address
First Line : 1031 BELLEVUE AVE STE 200
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63117-1856
Country : US
Telephone Number : 314-644-5650
Fax Number : 314-644-1524
Provider Business Practice Location Address
First Line : 1031 BELLEVUE AVE STE 200
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63117-1856
Country : US
Telephone Number : 314-644-5650
Fax Number : 314-644-1524
Authorized Official
Title or Position : RN/OFFICE MANAGER
Name : MS. NANCY BODET
Credential : RN
Telephone Number : 314-644-5650
Provider Enumeration Date : 10/12/2007
Last Update Date : 11/15/2007

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Directions to “MIDWEST CARDIOVASCULAR, INC. ” Practice Location

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