Provider Demographics
NPI:1649297698
Name:MIDWEST HEART & VASCULAR
Entity type:Organization
Organization Name:MIDWEST HEART & VASCULAR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:660-829-3400
Mailing Address - Street 1:4400 S LIMIT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-0505
Mailing Address - Country:US
Mailing Address - Phone:660-829-3400
Mailing Address - Fax:660-829-3433
Practice Address - Street 1:4400 S LIMIT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-0505
Practice Address - Country:US
Practice Address - Phone:660-829-3400
Practice Address - Fax:660-829-3433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505430702Medicaid
MO1649297698OtherNPI GROUP
MON570000Medicare ID - Type Unspecified
MO1649297698OtherNPI GROUP
MO505430702Medicaid