Provider Demographics
NPI:1184158354
Name:MIDWEST EXPRESS CARE 3 LLC
Entity type:Organization
Organization Name:MIDWEST EXPRESS CARE 3 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MILAP
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-631-2781
Mailing Address - Street 1:12200 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-1398
Mailing Address - Country:US
Mailing Address - Phone:708-631-2781
Mailing Address - Fax:708-631-2783
Practice Address - Street 1:12200 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-1398
Practice Address - Country:US
Practice Address - Phone:708-631-2781
Practice Address - Fax:708-631-2783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care