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CAH141302-01 Midwest Medical Center (Active)
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Main Details
Name
Midwest Medical Center
Subdivision Name
Midwest Health Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH141302-01
Medicare Provider Number
141302
Outpatient Facility Provider Number
148511
Additional Details
Current Program Status
Active
Registration Date
10/7/2013
Participating Start Date
1/1/2014
Participating Approval Date
11/3/2013
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Midwest Medical Center
Tracy Bauer, CEO
(815) 776-7266
Primary Contact
Midwest Medical Center
Kelli Marie Jackson, Controller
(815) 776-7277
Addresses
Street Address
One Medical Center Drive
Galena, IL 61036
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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