Provider Demographics
NPI:1154921294
Name:MIDWEST EXPRESS CARE 4, LLC
Entity type:Organization
Organization Name:MIDWEST EXPRESS CARE 4, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILAP
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-802-8800
Mailing Address - Street 1:PO BOX 775342
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5342
Mailing Address - Country:US
Mailing Address - Phone:219-841-8788
Mailing Address - Fax:
Practice Address - Street 1:6131 US HIGHWAY 6 STE C
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5058
Practice Address - Country:US
Practice Address - Phone:219-841-9788
Practice Address - Fax:219-254-2364
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST EXPRESS CARE 4, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-28
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care