1306280565 NPI number — MID-CONTINENT TECHNOLOGIES, LLC

Table of content: (NPI 1306280565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306280565 NPI number — MID-CONTINENT TECHNOLOGIES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID-CONTINENT TECHNOLOGIES, 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:
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:
1306280565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3000 2ND AVE
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
KEARNEY
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68847-3507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-403-1348
Provider Business Mailing Address Fax Number:
877-810-8046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 2ND AVE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
KEARNEY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68847-3507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-403-1348
Provider Business Practice Location Address Fax Number:
877-810-8046
Provider Enumeration Date:
04/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULZ
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
402-889-7432

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  01-11071729 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01-11071729 . This is a "STATE OF NEBRASKA ID NUMBER" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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