Provider Demographics
NPI:1548287527
Name:MIDWEST HEART RHYTHM INCORPORATED
Entity type:Organization
Organization Name:MIDWEST HEART RHYTHM INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:FREDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-317-9863
Mailing Address - Street 1:PO BOX 952273
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-2273
Mailing Address - Country:US
Mailing Address - Phone:314-432-2580
Mailing Address - Fax:314-432-0223
Practice Address - Street 1:222 S WOODS MILL RD
Practice Address - Street 2:SUITE 400N
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3625
Practice Address - Country:US
Practice Address - Phone:314-317-9863
Practice Address - Fax:314-317-9806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5G76207RC0001X
MOR4D51207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505207209Medicaid
MOCH4229OtherRAILROAD MEDICARE
MO000013355Medicare PIN