1902824956 NPI number — MIDWEST HEALTHSTRATEGIES, INC

Table of content: (NPI 1902824956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902824956 NPI number — MIDWEST HEALTHSTRATEGIES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST HEALTHSTRATEGIES, 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:
1902824956
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:
C/O GARNET E KING
Provider Second Line Business Mailing Address:
3813 S MADISON ST
Provider Business Mailing Address City Name:
MUNCIE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-213-3707
Provider Business Mailing Address Fax Number:
765-213-3888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1745 W 100 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-726-4020
Provider Business Practice Location Address Fax Number:
260-726-1805
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAVERTY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR/OFFICER
Authorized Official Telephone Number:
765-751-5072

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000230588 . This is a "ANTHEM BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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