Provider Demographics
NPI:1033186663
Name:MIDWEST MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:MIDWEST MEDICAL ASSOCIATES, INC
Other - Org Name:CLAYTON PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:CORDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-872-9900
Mailing Address - Street 1:3009 N BALLAS RD
Mailing Address - Street 2:SUITE 300A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2322
Mailing Address - Country:US
Mailing Address - Phone:314-872-9900
Mailing Address - Fax:314-872-3939
Practice Address - Street 1:3009 N BALLAS RD
Practice Address - Street 2:SUITE 300A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-872-9900
Practice Address - Fax:314-872-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO508139508Medicaid
MO508139508Medicaid
DB0927Medicare PIN