Provider Demographics
NPI:1295126944
Name:MIDWEST MEDICAL CENTER
Entity type:Organization
Organization Name:MIDWEST MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:815-777-1340
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:IL
Mailing Address - Zip Code:61036-8118
Mailing Address - Country:US
Mailing Address - Phone:815-777-1340
Mailing Address - Fax:815-776-7274
Practice Address - Street 1:117 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:IL
Practice Address - Zip Code:61028-8800
Practice Address - Country:US
Practice Address - Phone:815-858-2238
Practice Address - Fax:815-858-2239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center