Provider Demographics
NPI:1902030547
Name:MIDWEST MEDICAL, LLC
Entity Type:Organization
Organization Name:MIDWEST MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:G
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-881-6355
Mailing Address - Street 1:3116 MONTGOMERY RD STE C
Mailing Address - Street 2:SUITE 166
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-8606
Mailing Address - Country:US
Mailing Address - Phone:513-881-6355
Mailing Address - Fax:513-842-7832
Practice Address - Street 1:3116 MONTGOMERY RD STE C
Practice Address - Street 2:SUITE 166
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-8606
Practice Address - Country:US
Practice Address - Phone:513-881-6355
Practice Address - Fax:513-842-7832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies