Provider Demographics
NPI:1700475902
Name:MIDWEST MEDICAL FAMILY PRACTICE AND MENTAL HEALTH LLC
Entity type:Organization
Organization Name:MIDWEST MEDICAL FAMILY PRACTICE AND MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:VOUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:515-890-0156
Mailing Address - Street 1:1524 10TH AVE N
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IA
Mailing Address - Zip Code:50548-1070
Mailing Address - Country:US
Mailing Address - Phone:515-890-0156
Mailing Address - Fax:
Practice Address - Street 1:1524 10TH AVE N
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:IA
Practice Address - Zip Code:50548-1070
Practice Address - Country:US
Practice Address - Phone:515-890-0156
Practice Address - Fax:515-332-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty