Provider Demographics
NPI:1699932491
Name:ERGO MIDWEST INC
Entity type:Organization
Organization Name:ERGO MIDWEST INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN WCC
Authorized Official - Phone:314-226-4508
Mailing Address - Street 1:11993 BORMAN DR
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4114
Mailing Address - Country:US
Mailing Address - Phone:314-872-7760
Mailing Address - Fax:314-872-3575
Practice Address - Street 1:11993 BORMAN DR
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4114
Practice Address - Country:US
Practice Address - Phone:314-872-7760
Practice Address - Fax:314-872-3575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6223900002Medicare NSC