Provider Demographics
NPI:1942232269
Name:MIDWEST INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:MIDWEST INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:V
Authorized Official - Last Name:RHOADS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-626-8200
Mailing Address - Street 1:2817 MC CLELLAND BLVD STE 252
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1647
Mailing Address - Country:US
Mailing Address - Phone:417-626-8200
Mailing Address - Fax:417-626-8809
Practice Address - Street 1:2817 MC CLELLAND BLVD STE 252
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1647
Practice Address - Country:US
Practice Address - Phone:417-626-8200
Practice Address - Fax:417-626-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1F87207QA0505X
MOR7E45207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty