1154496305 NPI number — MINTER NUTRITION SERVICES, INC.

Table of content: (NPI 1154496305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154496305 NPI number — MINTER NUTRITION SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MINTER NUTRITION SERVICES, 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:
EARTHCARE
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:
1154496305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 629
Provider Second Line Business Mailing Address:
20111 REGINA ROAD
Provider Business Mailing Address City Name:
NEW PARIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46553-0629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-202-0704
Provider Business Mailing Address Fax Number:
574-831-6795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20111 REGINA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW PARIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46553-9632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-202-0704
Provider Business Practice Location Address Fax Number:
574-831-6795
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MINTER
Authorized Official First Name:
KARLA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
574-202-0704

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  37000537A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 133VN1004X , with the licence number: 37000537A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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