Provider Demographics
NPI:1124216023
Name:MIDAMERICA BASEMENT SYSTEMS
Entity Type:Organization
Organization Name:MIDAMERICA BASEMENT SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:TATGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-381-1700
Mailing Address - Street 1:13705 110TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-9034
Mailing Address - Country:US
Mailing Address - Phone:563-381-1700
Mailing Address - Fax:563-381-1900
Practice Address - Street 1:13705 110TH AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-9034
Practice Address - Country:US
Practice Address - Phone:563-381-1700
Practice Address - Fax:563-381-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies