Provider Demographics
NPI:1851729552
Name:MIDWEST WELLNESS INSTITUTE, PLLC
Entity Type:Organization
Organization Name:MIDWEST WELLNESS INSTITUTE, PLLC
Other - Org Name:MIDWEST WELLNESS INSTITUTE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO, MIDWEST WELLNESS INSTITUTE
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KORVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-573-2000
Mailing Address - Street 1:809 W PIPESTONE AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:FLANDREAU
Mailing Address - State:SD
Mailing Address - Zip Code:57028
Mailing Address - Country:US
Mailing Address - Phone:507-337-0556
Mailing Address - Fax:507-337-0567
Practice Address - Street 1:4308 S ARWAY DR
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3131
Practice Address - Country:US
Practice Address - Phone:507-337-0556
Practice Address - Fax:507-337-0567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD7035261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS1018222Medicare PIN