1982834263 NPI number — MIDWEST HEALTH SERVICES INC.

Table of content: (NPI 1982834263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982834263 NPI number — MIDWEST HEALTH SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST HEALTH SERVICES 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:
MIDWEST HEALTH SERVICES HOME 1
Provider Other Organization Name Type Code:
5
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:
1982834263
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 LINCOLN WAY W
Provider Second Line Business Mailing Address:
STE 5A
Provider Business Mailing Address City Name:
MASSILLON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44647-6585
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-674-2281
Provider Business Mailing Address Fax Number:
330-833-7732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5650 TR 332 STAR RTE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLERSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-674-2281
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KNETZER
Authorized Official First Name:
JOSPEH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
330-832-9582

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , with the licence number:  3810031 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2940492 . This is a "MEDICAID VENDOR NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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