Provider Demographics
NPI:1629502810
Name:MIDWEST EXPRESS CARE 4 LLC
Entity Type:Organization
Organization Name:MIDWEST EXPRESS CARE 4 LLC
Other - Org Name:MIDWEST EXPRESS CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MILAP
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-631-2781
Mailing Address - Street 1:31 SIBLEY ST
Mailing Address - Street 2:STE A
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46320-1725
Mailing Address - Country:US
Mailing Address - Phone:708-631-2781
Mailing Address - Fax:708-631-2783
Practice Address - Street 1:31 SIBLEY ST
Practice Address - Street 2:STE A
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-1725
Practice Address - Country:US
Practice Address - Phone:708-631-2781
Practice Address - Fax:708-631-2783
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST EXPRESS CARE 4 LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies