Provider Demographics
NPI:1760086540
Name:MIDWEST HOME PHYSICIANS INC
Entity Type:Organization
Organization Name:MIDWEST HOME PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-243-9188
Mailing Address - Street 1:1536 SAINT CLAIR AVE NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-2004
Mailing Address - Country:US
Mailing Address - Phone:216-243-9188
Mailing Address - Fax:
Practice Address - Street 1:1536 SAINT CLAIR AVE NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-2004
Practice Address - Country:US
Practice Address - Phone:216-243-9188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHICAGO MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty