Provider Demographics
NPI:1366000580
Name:MIDWEST/EDGERTON MEDICAL SERVICES, INC.
Entity type:Organization
Organization Name:MIDWEST/EDGERTON MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-315-4173
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:MIDWEST
Mailing Address - State:WY
Mailing Address - Zip Code:82643-0356
Mailing Address - Country:US
Mailing Address - Phone:307-315-4173
Mailing Address - Fax:307-437-6514
Practice Address - Street 1:531 PEAKE ST.
Practice Address - Street 2:
Practice Address - City:MIDWEST
Practice Address - State:WY
Practice Address - Zip Code:82643
Practice Address - Country:US
Practice Address - Phone:307-315-4173
Practice Address - Fax:307-437-6514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty