Provider Demographics
NPI:1699447540
Name:MIDWEST EMERGENCY TELL CITY, INC
Entity type:Organization
Organization Name:MIDWEST EMERGENCY TELL CITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
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:618-624-3368
Mailing Address - Street 1:320 E HIGHWAY 50
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2704
Mailing Address - Country:US
Mailing Address - Phone:618-624-3368
Mailing Address - Fax:618-624-3387
Practice Address - Street 1:8885 IN-237
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586
Practice Address - Country:US
Practice Address - Phone:618-624-3368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty