Provider Demographics
NPI:1376300137
Name:MIDWEST ADDICTION TREATMENT SERVICES LLC
Entity Type:Organization
Organization Name:MIDWEST ADDICTION TREATMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:COBARRUVIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:715-807-7917
Mailing Address - Street 1:450 S GREEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017
Mailing Address - Country:US
Mailing Address - Phone:715-807-7917
Mailing Address - Fax:
Practice Address - Street 1:450 S GREEN AVE
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017
Practice Address - Country:US
Practice Address - Phone:715-807-7917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty