Provider Demographics
NPI:1396337473
Name:MIDWEST OB GYN OF MISSOURI, LLC
Entity type:Organization
Organization Name:MIDWEST OB GYN OF MISSOURI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATTY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-772-7000
Mailing Address - Street 1:PO BOX 1007
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63902-1007
Mailing Address - Country:US
Mailing Address - Phone:573-772-7000
Mailing Address - Fax:573-686-1315
Practice Address - Street 1:2210 BARRON RD STE 206
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-1908
Practice Address - Country:US
Practice Address - Phone:573-772-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST OB GYN OF MISSOURI, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-09
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health