Provider Demographics
NPI:1588133680
Name:MIDWEST EXPRESS CARE 4 LLC
Entity type:Organization
Organization Name:MIDWEST EXPRESS CARE 4 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILAP
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-802-8800
Mailing Address - Street 1:31 SIBLEY ST STE A
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46320-1725
Mailing Address - Country:US
Mailing Address - Phone:219-802-8800
Mailing Address - Fax:219-802-8801
Practice Address - Street 1:5521 W LINCOLN HWY STE 1A
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-1098
Practice Address - Country:US
Practice Address - Phone:219-769-1362
Practice Address - Fax:219-769-8298
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST EXPRESS CARE 4 LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care