Provider Demographics
NPI:1962249839
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:CC SPECIALIST LEAD
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-789-6574
Mailing Address - Street 1:PO BOX 775342
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5342
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5995 US HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-4945
Practice Address - Country:US
Practice Address - Phone:219-963-8234
Practice Address - Fax:219-444-4504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies