1164535068 NPI number — MIDTOWN INVESTMENTS LLC

Table of content: (NPI 1164535068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164535068 NPI number — MIDTOWN INVESTMENTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDTOWN INVESTMENTS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CUSTOM MEDICAL SOLUTIONS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164535068
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7100 NORTHLAND CIR N
Provider Second Line Business Mailing Address:
SUITE 410
Provider Business Mailing Address City Name:
BROOKLYN PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55428-1548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-535-0118
Provider Business Mailing Address Fax Number:
612-294-3289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8601 73RD AVE N
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
BROOKLYN PARK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55428-1507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-535-5906
Provider Business Practice Location Address Fax Number:
763-535-5965
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARDSON
Authorized Official First Name:
JASON
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
601-842-7380

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 116212 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 610629200 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 41756300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4980432 . This is a "MEDICA MSHO PRODUCTS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 81G77CU . This is a "BCBS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8290222 . This is a "MEDICA COMMERCIAL PRODUCT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 066124400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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