| Organization Name: | MIDWEST ILLINOIS ORTHOTICS LLC |
| NPI Number: | 1174968820 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DON HAVEY (DIRECTOR) |
| Mailing Address: | 11425 Dorsett Rd Ste B Maryland Heights |
| State: | MO US |
| Postal Code: | 630433445 |
| Phone Number: | 3147394408 |
| Fax Number: | 8887702935 |
| NPI Enumeration Date: | 05/08/2013 |
| NPI Last Update Date: | 08/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |