Provider Demographics
NPI:1922260132
Name:MIDWEST HEMORRHOID TREATMENT CENTER TOWN & COUNTRY LLC
Entity Type:Organization
Organization Name:MIDWEST HEMORRHOID TREATMENT CENTER TOWN & COUNTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:F
Authorized Official - Last Name:CLEMENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-991-9888
Mailing Address - Street 1:450 N NEW BALLAS RD STE 266N
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6859
Mailing Address - Country:US
Mailing Address - Phone:313-991-9888
Mailing Address - Fax:
Practice Address - Street 1:450 N NEW BALLAS RD
Practice Address - Street 2:SUITE 266
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6835
Practice Address - Country:US
Practice Address - Phone:314-991-9888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-29
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty