1578129342 NPI number — MIDWAY HOME HEALTH CARE, INC.

Table of content: (NPI 1578129342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578129342 NPI number — MIDWAY HOME HEALTH CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWAY HOME HEALTH CARE, 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:
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:
1578129342
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1459 RICE ST STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55117-3864
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-793-6901
Provider Business Mailing Address Fax Number:
651-776-5251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1459 RICE ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55117-3864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-793-6901
Provider Business Practice Location Address Fax Number:
651-776-5251
Provider Enumeration Date:
05/16/2019

Additional Information

Authorized Official

Authorized Official Last Name:
VANG
Authorized Official First Name:
KAYING
Authorized Official Middle Name:
LOR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
651-793-6901

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 170038 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: R-125199-7 . This is a "MHP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 635-T4MI . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1085005-2-HCBS , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 49-80531 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 81215 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1750461042 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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