Provider Demographics
NPI:1740413152
Name:MIDWEST PAIN AND REHABILITATION CLINIC LTD.
Entity Type:Organization
Organization Name:MIDWEST PAIN AND REHABILITATION CLINIC LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYUNG
Authorized Official - Middle Name:JOO
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-322-7524
Mailing Address - Street 1:3934 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6513
Mailing Address - Country:US
Mailing Address - Phone:605-322-7524
Mailing Address - Fax:605-322-7546
Practice Address - Street 1:3934 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6513
Practice Address - Country:US
Practice Address - Phone:605-322-7524
Practice Address - Fax:605-322-7546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2781261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS9831Medicare UPIN