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CAH141302-02 Midwest Medical Center (Active)
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Main Details
Name
Midwest Medical Center
Subdivision Name
MIDWEST HEALTH CLINIC OF ELIZABETH
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH141302-02
Medicare Provider Number
141302
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/6/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/23/2016
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
117N MAIN ST
ELIZABETH, IL 61028-8800
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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