Organization
MIDWEST EMERGENCY DEPARTMENT SPECIALISTS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY HARVEY M.D. (PRESIDENT)
(217) 788-3156
Entity
Organization
Contact information
Practice address
701 N 1ST ST, SPRINGFIELD, IL 62781-0001
(217) 788-3156
Mailing address
PO BOX 955277, SAINT LOUIS, MO 63195-5277
(217) 788-4884
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08432052
BLUE CROSS BLUE SHIELD
IL
01
—
CK6793
RAILROAD MEDICARE
IL
Enumeration date
07/09/2006
Last updated
03/07/2022
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