Provider Demographics
NPI:1568895134
Name:MIDWEST ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:MIDWEST ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY / TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:SHEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-262-6210
Mailing Address - Street 1:9 FIELDCREST LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-1727
Mailing Address - Country:US
Mailing Address - Phone:816-262-6210
Mailing Address - Fax:
Practice Address - Street 1:4229 FREDERICK AVE STE B
Practice Address - Street 2:STE B
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3159
Practice Address - Country:US
Practice Address - Phone:816-262-6210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-18
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy