Provider Demographics
NPI:1760855738
Name:MIDWEST HEART AND VEIN CENTER, LLC
Entity Type:Organization
Organization Name:MIDWEST HEART AND VEIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:HABIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:660-263-2400
Mailing Address - Street 1:1513 UNION AVE
Mailing Address - Street 2:SUITE 2750
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-9402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1513 UNION AVE
Practice Address - Street 2:SUITE 2750
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-9402
Practice Address - Country:US
Practice Address - Phone:660-263-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty