Provider Demographics
NPI:1316545189
Name:MIDWAY MEDICAL CENTER
Entity Type:Organization
Organization Name:MIDWAY MEDICAL CENTER
Other - Org Name:MIDWAY TURNING POINT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-489-4715
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-0212
Mailing Address - Country:US
Mailing Address - Phone:313-489-4715
Mailing Address - Fax:
Practice Address - Street 1:2 W 103RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-2619
Practice Address - Country:US
Practice Address - Phone:313-489-4715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWAY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-14
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase ManagementGroup - Single Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6676700Medicaid