Provider Demographics
NPI:1437196623
Name:MIDWEST EMERGENCY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MIDWEST EMERGENCY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTZCLAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-887-4718
Mailing Address - Street 1:PO BOX 637542
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:865-292-3000
Mailing Address - Fax:865-470-0851
Practice Address - Street 1:1555 BARRINGTON RD
Practice Address - Street 2:ST ALEXIUS MEDICAL CENTER
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60194
Practice Address - Country:US
Practice Address - Phone:847-843-2000
Practice Address - Fax:630-734-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCJ2285OtherRAILROAD
IL1437196623Medicaid
IL1437196623Medicaid