Provider Demographics
NPI:1831668458
Name:MIDWAY EMS
Entity Type:Organization
Organization Name:MIDWAY EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:FAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-990-9589
Mailing Address - Street 1:5155 TORQUE RD # B
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-7144
Mailing Address - Country:US
Mailing Address - Phone:815-708-7232
Mailing Address - Fax:
Practice Address - Street 1:5155 TORQUE RD # B
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-7144
Practice Address - Country:US
Practice Address - Phone:815-708-7232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance