Provider Demographics
NPI:1760921472
Name:MIDWEST INTEGRATIVE HEALTH
Entity Type:Organization
Organization Name:MIDWEST INTEGRATIVE HEALTH
Other - Org Name:ENVISION WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACEY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FOLKERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-281-0825
Mailing Address - Street 1:4611 S 96TH ST
Mailing Address - Street 2:SUITE 139
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1202
Mailing Address - Country:US
Mailing Address - Phone:402-281-0825
Mailing Address - Fax:402-281-0852
Practice Address - Street 1:4611 S 96TH ST
Practice Address - Street 2:SUITE 139
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1202
Practice Address - Country:US
Practice Address - Phone:402-281-0825
Practice Address - Fax:402-281-0852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service