Provider Demographics
NPI:1962834390
Name:MIDWEST UROLOGY CENTER, PC
Entity Type:Organization
Organization Name:MIDWEST UROLOGY CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHOENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:417-781-7220
Mailing Address - Street 1:PO BOX 2220
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2220
Mailing Address - Country:US
Mailing Address - Phone:417-781-7220
Mailing Address - Fax:417-781-5512
Practice Address - Street 1:1905 W 32ND ST STE 302
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1512
Practice Address - Country:US
Practice Address - Phone:417-781-7220
Practice Address - Fax:417-781-5512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4695001OtherMEDICARE PROVIDER PTAN
MA4695OtherMEDICARE GROUP PTAN