Provider Demographics
NPI:1487601506
Name:MIDWEST EMERGENCY MANAGEMENT, INC.
Entity type:Organization
Organization Name:MIDWEST EMERGENCY MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CMO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARMON
Authorized Official - Middle Name:L
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:888-577-6337
Mailing Address - Street 1:PO BOX 797069
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-7000
Mailing Address - Country:US
Mailing Address - Phone:888-577-6337
Mailing Address - Fax:618-624-3387
Practice Address - Street 1:1512 N GREEN MOUNT RD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1953
Practice Address - Country:US
Practice Address - Phone:618-624-3750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08232205OtherBLUE CROSS BLUE SHIELD
ILDF2610OtherRAILROAD MEDICARE
IL08232205OtherBLUE CROSS BLUE SHIELD