Provider Demographics
NPI:1003872771
Name:MIDWEST FAMILY MEDICINE CLINIC PC
Entity Type:Organization
Organization Name:MIDWEST FAMILY MEDICINE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CHESTER FRANCIS
Authorized Official - Last Name:CAMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:417-256-6866
Mailing Address - Street 1:1598 IMPERIAL CTR
Mailing Address - Street 2:SUITE 2009
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-1818
Mailing Address - Country:US
Mailing Address - Phone:417-256-6866
Mailing Address - Fax:417-256-4263
Practice Address - Street 1:1598 IMPERIAL CTR
Practice Address - Street 2:SUITE 2009
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-1818
Practice Address - Country:US
Practice Address - Phone:417-256-6866
Practice Address - Fax:417-256-4263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112624207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO248884710Medicaid
1356343826OtherDR CAMIRES NPI
MO000013898Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
MO248884710Medicaid
MO010013898Medicare PIN