Provider Demographics
NPI:1194776815
Name:MIDWEST MEDICAL ASSOCIATES, INC
Entity type:Organization
Organization Name:MIDWEST MEDICAL ASSOCIATES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:IMAGING SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-821-7227
Mailing Address - Street 1:3825 S LINDBERGH BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1356
Mailing Address - Country:US
Mailing Address - Phone:317-821-7227
Mailing Address - Fax:314-821-2552
Practice Address - Street 1:3825 S LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1356
Practice Address - Country:US
Practice Address - Phone:317-821-7227
Practice Address - Fax:314-821-2552
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST MEDICAL ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-15
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOCH3968OtherRR MEDICARE
MO502461700Medicaid
MOCH3968OtherRR MEDICARE