Provider Demographics
NPI:1295287928
Name:MIDWEST EXPRESS CARE, INC
Entity type:Organization
Organization Name:MIDWEST EXPRESS CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-440-7373
Mailing Address - Street 1:1500 INDIANAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1316
Mailing Address - Country:US
Mailing Address - Phone:219-440-7373
Mailing Address - Fax:
Practice Address - Street 1:1500 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1316
Practice Address - Country:US
Practice Address - Phone:219-440-7373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST EXPRESS CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01076077A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty