Midwest Health Group LLC
Organization Active NPI Family Medicine Physician · Farmington, MO
NPI 1295857340 · NPPES record last updated Sep 4, 2018
Key facts
- NPI
- 1295857340
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- MIDWEST HEALTH GROUP LLC
- Practice address
- 555 West Pine Street
Farmington, MO 63640 - Phone
- (573) 747-1510
- Fax
- (573) 747-1080
- NPI assigned
- Apr 6, 2007
- Organization subpart
- No
Authorized official
- Name
- Paul S Moniz, D.O.
- Title
- Owner
- Phone
- (573) 747-1510
Subparts reporting this organization as parent 1
Corporate family (same tax ID) 1
Practitioners 15
-
Zacharias Alan Dane, FNP-C
-
Angelica M Lappe, FNP
-
Paul S Moniz, DO
-
Guy D Roberts, D.O.
-
April Brannum, FNP-C
-
Misty Dawn Cain, FNP
-
Victoria A Damba, DO
-
Gina Heberlie, NP
-
Julie M Koppeis McTearnen, FNP,BC
-
Lisa Mengwasser, FNP
-
Christina Ann Rariden, FNP, PMHNP
-
Kelly M Roberts, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070920000034 | MO | Part B Supplier - Clinic/Group Practice | 7214021385 |
Receives reassigned benefits from 15 practitioners Practice locations: Farmington, MO |
National Provider Directory
- Tax ID family
- Midwest Health Group LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
555 West Pine Street
Farmington, MO 63640
Mailing address
555 West Pine Street
Farmington, MO 63640
Phone (573) 747-1510
Other providers in Farmington, MO
- Wenona H Mickan
- Mid-America Clinical Pathology, LLC
- Mid-West Podiatry & Associates, L L C
- Midwest Health Group Convenient Care
- Midwest Health Group Convenient Care, LLC
- Midwest Health Group, LLC
- Midwest Imaging Center, LLC
- Midwest Sleep Lab LLC
- Midwest Wound & Wellness LLC
- Ashley Marie Miesner
All providers in Farmington, MO · Family Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 4, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.