Provider Demographics
NPI:1790784171
Name:MIDWEST PHYSICIANS & SURGEONS PC
Entity Type:Organization
Organization Name:MIDWEST PHYSICIANS & SURGEONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. AND OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-651-4488
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63702-0070
Mailing Address - Country:US
Mailing Address - Phone:573-651-4488
Mailing Address - Fax:573-651-4431
Practice Address - Street 1:300 S MOUNT AUBURN RD
Practice Address - Street 2:STE 100
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4920
Practice Address - Country:US
Practice Address - Phone:573-651-4488
Practice Address - Fax:573-651-4431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO508077401Medicaid
000012332Medicare ID - Type Unspecified