1295891448 NPI number — MIDTOWN INVESTMENTS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295891448 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:
1295891448
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:
763-536-0932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 DOOLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29073-7614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-359-3366
Provider Business Practice Location Address Fax Number:
803-359-3367
Provider Enumeration Date:
12/29/2006

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 , with the licence number:  032393419 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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