MIDWEST HEART GROUP OF ROLLA, LLC (NPI# 1700068616) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700068616 |
| Entity Type | Organization |
| Organization Name | MIDWEST HEART GROUP OF ROLLA, LLC |
| Practice Address |
100 W 10th St Suite 100 Rolla MO 65401-3248 |
| Practice Telephone | 5734266751 |
| Practice Fax Number | 5734266752 |
| Mailing Telephone | 5734266751 |
| Mailing Fax Number | 5734266752 |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2007-12-03 |
| Authorized Official Name | JOHN G. HERMANN (PRESIDENT) |
| Authorized Official Telephone | 3143643380 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| Street Address |
100 W 10TH ST SUITE 100 |
| City | ROLLA |
| State | MO |
| Zip Code | 65401-3248 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639645591 | Samantha Jo Mitchell | Pharmacist | 1375 E 10th St Suite B, Rolla, MO 65401 | 2018-10-18 |
| 1427567726 | Gerry Wade Funkhouser Jr. | Counselor | 103 W 10th St, Rolla, MO 65401 | 2017-09-29 |
| 1366967960 | Shana Hintz Wisniewski | Social Worker | 1000 W. 10th St., Rolla, MO 65401 | 2017-08-04 |
| 1174066559 | Tabitha Hundt | Counselor | 1011 Cypress Dr, Rolla, MO 65401 | 2016-12-02 |
| 1841742855 | Alpha Assisted Living LLC | Assisted Living Facility | 13450 Cr 7040, 803 E 12th St, Rolla, MO 65401 | 2016-10-26 |
| 1275916884 | Elizabeth Zersen | Occupational Therapist | 2053 Vienna Rd, Rolla, MO 65401 | 2015-06-30 |
| 1386047025 | Becky L Witham | Nurse Practitioner | 1060 W 10th Street, Rolla, MO 65401 | 2014-10-08 |
| 1114326121 | Summer Adey | Licensed Practical Nurse | 13750 State Route F, Rolla, MO 65401 | 2014-08-14 |
| 1518303296 | Leaetta Mildred Gardner | Nursing Facility/Intermediate Care Facility | 13450 County Road 7040, Rolla, MO 65401 | 2013-05-21 |
| 1316282064 | Susan Peitz Gruener | Occupational Therapy Assistant | 1800 White Column Road, Rolla, MO 65401 | 2012-12-06 |
| Find all providers in zip 65401 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366486722 | Timothy J Martin | Internal Medicine | 1050 W 10th St Ste 500, Rolla, MO 65401 | 2006-06-16 |
| 1528409638 | Curtis Morrison | Internal Medicine | 1050 W 10th St, Rolla, MO 65401-2905 | 2013-07-17 |
| 1194161174 | Dmitry Familtsev | Internal Medicine | 1050 W 10th St, Rolla, MO 65401-2905 | 2013-05-16 |
| 1942419452 | Daniel Lee Wagner | Internal Medicine | 1000 W 10th St, Rolla, MO 65401-2905 | 2007-05-21 |
| 1205848736 | Thomas F Martin | Internal Medicine | 1050 W 10th St, Ste 500, Rolla, MO 65401-2905 | 2006-08-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689128019 | Midwest Heart Institute | Internal Medicine | 1439 Us Highway 61, Ste A, Festus, MO 63028-4153 | 2016-08-15 |
| 1477984292 | Robert A. Brinkman, M.d., LLC. | Internal Medicine | 1040 N Mason Rd Ste 211, Creve Coeur, MO 63141 | 2013-12-04 |
| 1528407822 | Justin Patrick Sheehy | Internal Medicine | 4401 Wornall Rd Fl 9, Kansas City, MO 64111-3220 | 2013-06-19 |
| 1952643520 | Meritas Health Corporation | Internal Medicine | 5501 Nw 62nd Ter Ste 201, Kansas City, MO 64151-2408 | 2013-03-21 |
| 1043557150 | Ronald Nathan Riner | Internal Medicine | 9847 Waterbury Drive, St. Louis, MO 63124 | 2013-01-09 |
| 1427315423 | Paul Larsen | Internal Medicine | 1027 Bellevue Ave Ste 200, Saint Louis, MO 63117-1851 | 2012-04-13 |
| 1275899718 | Bradley Carl Witbrodt | Internal Medicine | 3023 N Ballas Rd Ste 200, Saint Louis, MO 63131-2330 | 2012-04-10 |
| 1194004952 | Jad Raffoul | Internal Medicine | 1402 S Grand Blvd Fl 14, Saint Louis, MO 63104-1004 | 2011-08-11 |
| 1376839894 | Chetan P Huded | Internal Medicine | 5844 Nw Barry Rd Ste 230, Kansas City, MO 64154-1421 | 2011-06-22 |
| 1982999462 | Philip L Mar | Internal Medicine | 3635 Vista Ave Fl 15, Saint Louis, MO 63110-2539 | 2011-06-13 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.