| NPI | 1780199026 |
|---|---|
| Doing Business As | HEALTHEAST MIDWAY CLINIC MTM |
| Entity Type | Organization |
| Authorized Contact | DAVID FASCHING CFO 612-617-3799 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2017-12-08 |
| Last Update Date | 2023-04-13 |