Provider Demographics
NPI:1356603716
Name:MIDWEST INFUSION SERVICES, LLC
Entity type:Organization
Organization Name:MIDWEST INFUSION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-881-4994
Mailing Address - Street 1:1730 E REPUBLIC RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6549
Mailing Address - Country:US
Mailing Address - Phone:417-881-4994
Mailing Address - Fax:417-881-4998
Practice Address - Street 1:1730 E REPUBLIC RD
Practice Address - Street 2:SUITE K
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6549
Practice Address - Country:US
Practice Address - Phone:417-881-4994
Practice Address - Fax:417-881-4998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy