1326285495 NPI number — MIDWEST INSTITUTE OF TRAINING AND DEVELOPMENT

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 1326285495 NPI number — MIDWEST INSTITUTE OF TRAINING AND DEVELOPMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST INSTITUTE OF TRAINING AND DEVELOPMENT
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:
1326285495
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 W WASHINGTON ST
Provider Second Line Business Mailing Address:
STE 1910
Provider Business Mailing Address City Name:
SOUTH BEND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46601-1711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-292-6553
Provider Business Mailing Address Fax Number:
574-232-0124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
STE 1910
Provider Business Practice Location Address City Name:
SOUTH BEND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46601-1711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-292-6553
Provider Business Practice Location Address Fax Number:
574-232-0124
Provider Enumeration Date:
01/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GRASK
Authorized Official First Name:
KAY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
574-292-6553

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  35000665A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 34000195A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100460830A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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