1891771663 NPI number — MMSC VENTURES INC

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 1891771663 NPI number — MMSC VENTURES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MMSC VENTURES INC
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:
Provider Other Organization Name Type Code:
6
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:
1891771663
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 SOUTH 4TH AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARSHALLTOWN
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50158-2998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-754-5151
Provider Business Mailing Address Fax Number:
641-754-5181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
503 3RD AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATE CENTER
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50247-7719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-483-2141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DOWNEY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
VICE PRESIDENT OF FINANCE
Authorized Official Telephone Number:
641-754-5125

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0685214 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47411 . This is a "BLUE SHIELD OF IOWA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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