Provider Demographics
NPI:1619536067
Name:MIDWEST EXPRESS CARE 4 LLC
Entity Type:Organization
Organization Name:MIDWEST EXPRESS CARE 4 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILAP
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-802-8800
Mailing Address - Street 1:PO BOX 775342
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5342
Mailing Address - Country:US
Mailing Address - Phone:219-554-3290
Mailing Address - Fax:219-554-3291
Practice Address - Street 1:5043 E 81ST AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5912
Practice Address - Country:US
Practice Address - Phone:219-554-3290
Practice Address - Fax:219-554-3291
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST EXPRESS CARE 4, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care