Provider Demographics
NPI:1952409765
Name:MIDWEST MEDICAL CENTER
Entity type:Organization
Organization Name:MIDWEST MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO/CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-776-7277
Mailing Address - Street 1:ONE MEDICAL CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:IL
Mailing Address - Zip Code:61036-1635
Mailing Address - Country:US
Mailing Address - Phone:815-777-2560
Mailing Address - Fax:
Practice Address - Street 1:ONE MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:IL
Practice Address - Zip Code:61036-1635
Practice Address - Country:US
Practice Address - Phone:815-776-7274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0005389282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14-8511OtherMEDICARE ID FOR RURAL HEALTH CLINIC FROM DEPARTMENT OF HEALTH AND HUMAN SERVICE
IL14-8511OtherMEDICARE ID FOR RURAL HEALTH CLINIC FROM DEPARTMENT OF HEALTH AND HUMAN SERVICE
IL=========001Medicaid
IL14Z302Medicare ID - Type Unspecified