Provider Demographics
NPI:1225371487
Name:MIDWEST MEDICAL ALLIANCE LLC
Entity Type:Organization
Organization Name:MIDWEST MEDICAL ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-697-0443
Mailing Address - Street 1:PO BOX 33
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:IL
Mailing Address - Zip Code:61535-0033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:119 NICHOLAS DR
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:IL
Practice Address - Zip Code:61535-9564
Practice Address - Country:US
Practice Address - Phone:630-697-0443
Practice Address - Fax:888-455-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies