Provider Demographics
NPI:1184644981
Name:MIDWEST MEDICAL HEALTHCARE, LTD.
Entity Type:Organization
Organization Name:MIDWEST MEDICAL HEALTHCARE, LTD.
Other - Org Name:MIDWEST WOMEN'S CARE, LTD.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-355-7745
Mailing Address - Street 1:340 W LINCOLN ST STE 560
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1900
Mailing Address - Country:US
Mailing Address - Phone:618-355-7745
Mailing Address - Fax:161-835-5759
Practice Address - Street 1:340 W LINCOLN ST STE 560
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1900
Practice Address - Country:US
Practice Address - Phone:618-355-7745
Practice Address - Fax:161-835-5759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100358207V00000X
MO131902363LW0102X
IL207V00000X, 363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Not Answered367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL85762Medicare ID - Type Unspecified
ILF28385Medicare UPIN