Provider Demographics
NPI:1699921999
Name:MIDWAY MEDICAL CENTER, PA
Entity type:Organization
Organization Name:MIDWAY MEDICAL CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:KINTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-627-2211
Mailing Address - Street 1:6750 CAROLINA BLVD
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-7052
Mailing Address - Country:US
Mailing Address - Phone:828-627-2211
Mailing Address - Fax:855-876-9354
Practice Address - Street 1:6750 CAROLINA BLVD
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-7052
Practice Address - Country:US
Practice Address - Phone:828-627-2211
Practice Address - Fax:855-876-9354
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWAY MEDICAL CENTER, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-18
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC62447207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4245150001OtherMEDICARE DME
NCC17128OtherRR MEDICARE
NC5900304Medicaid
NC2381378Medicare PIN