Provider Demographics
NPI:1427190354
Name:MIDWEST DIVISION-LSH.LLC
Entity Type:Organization
Organization Name:MIDWEST DIVISION-LSH.LLC
Other - Org Name:HOLDEN FAMILY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-969-6533
Mailing Address - Street 1:807 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MO
Mailing Address - Zip Code:64040-1291
Mailing Address - Country:US
Mailing Address - Phone:816-850-3612
Mailing Address - Fax:816-850-3982
Practice Address - Street 1:807 W 2ND ST
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MO
Practice Address - Zip Code:64040-1291
Practice Address - Country:US
Practice Address - Phone:816-850-3612
Practice Address - Fax:816-850-3982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO503228207Medicaid
MO593228208Medicaid
MO593228208Medicaid
MOX050000Medicare PIN
MO268618Medicare Oscar/Certification
MO268618Medicare PIN