NPIMap

Organization Active NPI

Midwest Integrated Medical Center LLC

  • Multi-Specialty Clinic/Center
  • Hudson, WI
National Provider Identifier
1770095796
Registry record updated Jan 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
MIDWEST INTEGRATED MEDICAL CENTER LLC
Practice address
2920 Enloe St Ste 105
Hudson, WI 54016-8191
Phone
(715) 808-0716
NPI assigned
Oct 31, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2018

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

Authorized official

Name
Dr. Daryl Cooper, DC
Title
Owner
Phone
(715) 808-0716

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

2920 Enloe St Ste 105
Hudson, WI 54016-8191

Mailing address

2920 Enloe St Ste 105
Hudson, WI 54016-8191
Phone (715) 808-0716

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1509408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516579200000",
    "number": "1770095796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 ENLOE ST STE 105",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540168191",
            "telephone_number": "715-808-0716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 ENLOE ST STE 105",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540168191",
            "telephone_number": "715-808-0716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST INTEGRATED MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-31",
        "last_updated": "2018-01-22",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "DARYL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-808-0716",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hudson, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2018; 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.