Provider Demographics
NPI:1386601474
Name:MIDWEST ORTHOPEDIC SERVICES SC
Entity type:Organization
Organization Name:MIDWEST ORTHOPEDIC SERVICES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:B
Authorized Official - Last Name:STACHNIW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-341-1300
Mailing Address - Street 1:834 N SEMINARY ST
Mailing Address - Street 2:SUITE #406
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-2852
Mailing Address - Country:US
Mailing Address - Phone:309-341-1300
Mailing Address - Fax:
Practice Address - Street 1:834 N SEMINARY ST
Practice Address - Street 2:SUITE #406
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2852
Practice Address - Country:US
Practice Address - Phone:309-341-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1386601474Medicare PIN
IL5725610001Medicare NSC