Provider Demographics
NPI:1306261474
Name:MIDWEST HEALTH GROUP
Entity type:Organization
Organization Name:MIDWEST HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:CLARE
Authorized Official - Last Name:TURNQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:763-232-6587
Mailing Address - Street 1:22228 GARNET ST NW
Mailing Address - Street 2:
Mailing Address - City:NOWTHEN
Mailing Address - State:MN
Mailing Address - Zip Code:55330-8431
Mailing Address - Country:US
Mailing Address - Phone:763-232-6587
Mailing Address - Fax:
Practice Address - Street 1:22228 GARNET ST NW
Practice Address - Street 2:
Practice Address - City:NOWTHEN
Practice Address - State:MN
Practice Address - Zip Code:55330-8431
Practice Address - Country:US
Practice Address - Phone:763-232-6587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health