Provider Demographics
NPI:1457897167
Name:MIDWEST TMS LLC
Entity Type:Organization
Organization Name:MIDWEST TMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PAVLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-864-1795
Mailing Address - Street 1:1309 OAK AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1080
Mailing Address - Country:US
Mailing Address - Phone:952-442-3828
Mailing Address - Fax:
Practice Address - Street 1:1309 OAK AVE STE 207
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1080
Practice Address - Country:US
Practice Address - Phone:952-442-3828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST WELLNESS INSTITUTE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47358261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)