Basic Information
| Provider Information | |||||||||
| NPI: | 1992380943 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACUTE CARE SURGERY MIDWEST, S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 208980 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753200001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164410400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7309 N KNOXVILLE AVE STE 1 | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 616142086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164410400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2021 | ||||||||
| LastUpdateDate: | 06/25/2021 | ||||||||
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| AuthorizedOfficialLastName: | REED | ||||||||
| AuthorizedOfficialFirstName: | SEAN | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF LEGAL AFFAIRS | ||||||||
| AuthorizedOfficialTelephone: | 9164410400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 06/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.