Provider Demographics
NPI:1881624591
Name:MIDWEST MEDICAL CARE PC
Entity type:Organization
Organization Name:MIDWEST MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHANDAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-310-2000
Mailing Address - Street 1:PO BOX 5126
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5126
Mailing Address - Country:US
Mailing Address - Phone:605-335-1952
Mailing Address - Fax:605-373-9971
Practice Address - Street 1:1905 W 57TH ST STE 1
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2893
Practice Address - Country:US
Practice Address - Phone:605-310-2000
Practice Address - Fax:605-271-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0459207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025352300Medicaid
SDDO9372OtherRAILROAD MEDICARE
SDS100920Medicare PIN