Provider Demographics
NPI:1871893834
Name:MIDWEST ACUTE CARE CONSULTANTS
Entity type:Organization
Organization Name:MIDWEST ACUTE CARE CONSULTANTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-355-7500
Mailing Address - Street 1:6698 KEATON CORPORATE PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8727
Mailing Address - Country:US
Mailing Address - Phone:636-928-0215
Mailing Address - Fax:636-928-0218
Practice Address - Street 1:6698 KEATON CORPORATE PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8727
Practice Address - Country:US
Practice Address - Phone:636-928-0215
Practice Address - Fax:636-928-0218
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST ACUTE CARE CONSULTANTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006001791207RP1001X
MO113412207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505805101Medicaid
MO505805101Medicaid