Provider Demographics
NPI:1295857340
Name:MIDWEST HEALTH GROUP LLC
Entity Type:Organization
Organization Name:MIDWEST HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MONIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-747-1510
Mailing Address - Street 1:555 WEST PINE STREET
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640
Mailing Address - Country:US
Mailing Address - Phone:573-747-1510
Mailing Address - Fax:573-747-1080
Practice Address - Street 1:555 WEST PINE STREET
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640
Practice Address - Country:US
Practice Address - Phone:573-747-1510
Practice Address - Fax:573-747-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG45908Medicare UPIN