| Midwest Nutrition, Pllc | |
|
103 North Ave Ste 8 Council Bluffs IA 51503-1613 | |
| (662) 322-9037 | |
| Not Available |
| Full Name | Midwest Nutrition, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 103 North Ave Ste 8, Council Bluffs, Iowa |
| Authorized Official Name and Position | Whitney Black (OWNER) |
| Authorized Official Contact | 6623229037 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midwest Nutrition, Pllc 8169 S 185th St Omaha NE 68136-6451 Ph: (662) 322-9037 | Midwest Nutrition, Pllc 103 North Ave Ste 8 Council Bluffs IA 51503-1613 Ph: (662) 322-9037 |
| NPI Number | 1124879788 |
|---|---|
| Provider Enumeration Date | 04/01/2024 |
| Last Update Date | 04/01/2024 |
| Medicare PECOS PAC ID | 0648715540 |
|---|---|
| Medicare Enrollment ID | O20240716001966 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124879788 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Whitney Black |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1629689989 PECOS PAC ID: 1557806452 Enrollment ID: I20240716002348 |
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