Basic Information
| Provider Information | |||||||||
| NPI: | 1467850073 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDWEST PHYSICIAN SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1702 N BALTIMORE ST | ||||||||
| Address2: | |||||||||
| City: | KIRKSVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 635012485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6606656262 | ||||||||
| FaxNumber: | 6606655908 | ||||||||
| Practice Location | |||||||||
| Address1: | 1702 N BALTIMORE ST | ||||||||
| Address2: | |||||||||
| City: | KIRKSVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 635012485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6606656262 | ||||||||
| FaxNumber: | 6606655908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2014 | ||||||||
| LastUpdateDate: | 12/16/2014 | ||||||||
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| AuthorizedOfficialLastName: | GIRA | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 6606656262 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.