Provider Demographics
NPI:1992324768
Name:MIDWEST REGIONAL TELEHEALTH LLC
Entity type:Organization
Organization Name:MIDWEST REGIONAL TELEHEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCMILLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-708-8853
Mailing Address - Street 1:931 SW LEMANS LN
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4619
Mailing Address - Country:US
Mailing Address - Phone:816-708-8853
Mailing Address - Fax:816-623-3076
Practice Address - Street 1:931 SW LEMANS LN
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-4619
Practice Address - Country:US
Practice Address - Phone:816-708-8853
Practice Address - Fax:816-623-3076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-13
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty