1497007751 NPI number — MIDAS TOUCH BUSINESS HOLDINGS, INC

Table of content: (NPI 1497007751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497007751 NPI number — MIDAS TOUCH BUSINESS HOLDINGS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDAS TOUCH BUSINESS HOLDINGS, 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:
1497007751
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
67 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47102-1303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-794-9181
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47102-1303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-794-9181
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
USHER
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
ELWOOD
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
812-794-9181

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  08001874A , 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: 85003499 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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