1700193935 NPI number — MIDLAND HEALTH TESTING SERVICES INC

Table of content: (NPI 1700193935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700193935 NPI number — MIDLAND HEALTH TESTING SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDLAND HEALTH TESTING 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:
MIDLAND HEALTH
Provider Other Organization Name Type Code:
3
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:
1700193935
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12523 W HAMPTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUTLER
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53007-1703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-754-3130
Provider Business Mailing Address Fax Number:
262-754-3125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11803 W NORTH AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUWATOSA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226-2077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-754-3130
Provider Business Practice Location Address Fax Number:
262-754-3125
Provider Enumeration Date:
09/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ARAUJO
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
262-754-3130

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  18823021 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com