Provider Demographics
NPI:1003171745
Name:MIDWEST SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:MIDWEST SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SONJAY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FONN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-651-1687
Mailing Address - Street 1:PO BOX 614
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63702-0614
Mailing Address - Country:US
Mailing Address - Phone:573-651-1687
Mailing Address - Fax:573-651-8734
Practice Address - Street 1:65 DOCTORS PARK
Practice Address - Street 2:SUITE B
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4927
Practice Address - Country:US
Practice Address - Phone:573-803-2007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA4624Medicare UPIN