MEDICARE: MIDWAY MEDICAL CENTER

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1982324075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWAY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 212
Second Line	:
City	:	CRETE
State	:	IL
Zip	:	60417-0212
Country	:	US
Telephone Number	:	773-251-8043
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 W 103RD ST STE A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-2619
Country	:	US
Telephone Number	:	312-489-4715
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	EUNICE T WALKER
Credential	:
Telephone Number	:	312-489-4715

Provider Enumeration Date	:	08/30/2022
Last Update Date	:	08/30/2022

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Directions to “MIDWAY MEDICAL CENTER ” Practice Location

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