Midwest Endoscopy Associates, PLLC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

Legal business name

MIDWEST ENDOSCOPY ASSOCIATES, PLLC

Practice address

4224 Lincolnshire Dr
Mount Vernon, IL 62864-2156

Phone

(314) 724-1348

NPI assigned

Jun 17, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. David Russell Horace

Title

Manager

Phone

(618) 973-8740

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623888000000",
    "number": "1598334252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 W LINCOLN ST",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622201921",
            "telephone_number": "618-235-2299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4224 LINCOLNSHIRE DR",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642156",
            "telephone_number": "314-724-1348"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "325 W Lincoln St",
            "address_purpose": "LOCATION",
            "city": "Belleville",
            "state": "IL",
            "postal_code": "622201921",
            "country_code": "US",
            "telephone_number": "618-235-2299",
            "fax_number": "618-235-2556",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "510 Fullerton Rd",
            "address_purpose": "LOCATION",
            "city": "Swansea",
            "state": "IL",
            "postal_code": "622262970",
            "country_code": "US",
            "telephone_number": "314-724-1348",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MIDWEST ENDOSCOPY ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-17",
        "last_updated": "2021-06-17",
        "certification_date": "2021-06-17",
        "status": "A",
        "authorized_official_last_name": "HORACE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "618-973-8740",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chelsee Miller, PHARMD

• Gastroenterology Physician in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Gastroenterology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.