Provider Demographics
NPI:1417996430
Name:MIDWEST MEDICAL MANAGEMENT, P.C.
Entity Type:Organization
Organization Name:MIDWEST MEDICAL MANAGEMENT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:833-732-1066
Mailing Address - Street 1:PO BOX 42329
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-2329
Mailing Address - Country:US
Mailing Address - Phone:800-732-1066
Mailing Address - Fax:630-941-4333
Practice Address - Street 1:1606 N 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-2706
Practice Address - Country:US
Practice Address - Phone:812-238-7000
Practice Address - Fax:812-238-7141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000101352OtherBLUE SHIELD
IN100239300AMedicaid
IN=========OtherCHAMPUS/TRICARE
IN=========OtherCHAMPUS/TRICARE
IN000000101352OtherBLUE SHIELD