Provider Demographics
NPI:1689739666
Name:MID-WEST PODIATRY & ASSOCIATES, L L C
Entity Type:Organization
Organization Name:MID-WEST PODIATRY & ASSOCIATES, L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HIEU
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-432-1903
Mailing Address - Street 1:500 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1426
Mailing Address - Country:US
Mailing Address - Phone:573-756-8986
Mailing Address - Fax:573-756-0419
Practice Address - Street 1:500 W PINE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1426
Practice Address - Country:US
Practice Address - Phone:573-756-8986
Practice Address - Fax:573-756-0419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO365905405Medicaid
MO365905413Medicaid
MO0805730008Medicare NSC
MO000012739Medicare PIN