Provider Demographics
NPI:1508993379
Name:MIDWEST CARDIOVASCULAR ULTRASOUND SERVICES, LLC
Entity Type:Organization
Organization Name:MIDWEST CARDIOVASCULAR ULTRASOUND SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-209-5700
Mailing Address - Street 1:1700 S CAMPBELL AVE STE J
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-2000
Mailing Address - Country:US
Mailing Address - Phone:417-209-5700
Mailing Address - Fax:833-792-4156
Practice Address - Street 1:1700 S CAMPBELL AVE STE J
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-2000
Practice Address - Country:US
Practice Address - Phone:417-719-4026
Practice Address - Fax:833-792-4156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Single Specialty