Provider Demographics
NPI:1134607369
Name:MIDWEST INNOVATIVE HEALTH INC
Entity type:Organization
Organization Name:MIDWEST INNOVATIVE HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-365-4070
Mailing Address - Street 1:99 Z ST
Mailing Address - Street 2:
Mailing Address - City:LAKE LOTAWANA
Mailing Address - State:MO
Mailing Address - Zip Code:64086-9769
Mailing Address - Country:US
Mailing Address - Phone:816-578-4548
Mailing Address - Fax:816-774-8132
Practice Address - Street 1:409 SE DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063
Practice Address - Country:US
Practice Address - Phone:816-578-4548
Practice Address - Fax:816-774-8132
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST INNOVATIVE HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-31
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty