Basic Information
| Provider Information | |||||||||
| NPI: | 1881928729 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDWEST CARE OLNEY EG LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 78 CENTENNIAL LOOP | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974017900 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1301 N EAST ST | ||||||||
| Address2: | |||||||||
| City: | OLNEY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624502430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183954663 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2009 | ||||||||
| LastUpdateDate: | 09/24/2009 | ||||||||
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| AuthorizedOfficialLastName: | KANG | ||||||||
| AuthorizedOfficialFirstName: | HOWARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF ACCOUNTING AND FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 5417473373 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305S00000X | Y | Managed Care Organizations | Point of Service |
No ID Information.