Provider Demographics
NPI:1649468786
Name:MIDWEST CARDIOVASCULAR, INC.
Entity type:Organization
Organization Name:MIDWEST CARDIOVASCULAR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:BODET
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:314-644-5650
Mailing Address - Street 1:1031 BELLEVUE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1856
Mailing Address - Country:US
Mailing Address - Phone:314-644-5650
Mailing Address - Fax:314-644-1524
Practice Address - Street 1:1031 BELLEVUE AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1856
Practice Address - Country:US
Practice Address - Phone:314-644-5650
Practice Address - Fax:314-644-1524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1E18207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1649468786OtherNPI
MO1649468786OtherNPI