Provider Demographics
NPI:1033479977
Name:TOWN OF MIDWEST
Entity Type:Organization
Organization Name:TOWN OF MIDWEST
Other - Org Name:MIDWEST COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAZI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAYDJARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-437-6513
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:MIDWEST
Mailing Address - State:WY
Mailing Address - Zip Code:82643-0190
Mailing Address - Country:US
Mailing Address - Phone:307-437-6513
Mailing Address - Fax:307-437-6514
Practice Address - Street 1:531 PEAKE STREET
Practice Address - Street 2:
Practice Address - City:MIDWEST
Practice Address - State:WY
Practice Address - Zip Code:82643-0190
Practice Address - Country:US
Practice Address - Phone:307-437-6513
Practice Address - Fax:307-437-6514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health