Provider Demographics
NPI:1578797031
Name:MIDWEST HEALTH GROUP CONVENIENT CARE
Entity Type:Organization
Organization Name:MIDWEST HEALTH GROUP CONVENIENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MONIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-454-2466
Mailing Address - Street 1:550 MAPLE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1981
Mailing Address - Country:US
Mailing Address - Phone:573-454-2466
Mailing Address - Fax:573-454-2544
Practice Address - Street 1:550 MAPLE VALLEY DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1981
Practice Address - Country:US
Practice Address - Phone:573-454-2466
Practice Address - Fax:573-454-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty