Provider Demographics
NPI:1275629669
Name:MIDWEST CARDIOLOGY, P.C.
Entity Type:Organization
Organization Name:MIDWEST CARDIOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:V
Authorized Official - Last Name:VEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-233-2220
Mailing Address - Street 1:4600 MEMORIAL DR
Mailing Address - Street 2:STE 100
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5366
Mailing Address - Country:US
Mailing Address - Phone:618-233-2220
Mailing Address - Fax:618-257-5754
Practice Address - Street 1:4600 MEMORIAL DR
Practice Address - Street 2:STE 100
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5366
Practice Address - Country:US
Practice Address - Phone:618-233-2220
Practice Address - Fax:618-257-5754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA302674207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212827Medicare ID - Type UnspecifiedGROUP NUMBER