1194055475 NPI number — MIDWEST MEDICAL ENTERPRISES, LLC

Table of content: ROBERT W. REMINGTON M.D. (NPI 1982886818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194055475 NPI number — MIDWEST MEDICAL ENTERPRISES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST MEDICAL ENTERPRISES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
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NPI Number Information

NPI Number:
1194055475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2295 PARKLAKE DRIVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30345-2816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-414-4260
Provider Business Mailing Address Fax Number:
877-593-9689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2295 PARKLAKE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30345-2816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-593-3546
Provider Business Practice Location Address Fax Number:
877-593-9689
Provider Enumeration Date:
01/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MINTON
Authorized Official First Name:
GREG
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OPERATIONS
Authorized Official Telephone Number:
877-414-4260

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  16-00186 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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