Provider Demographics
NPI:1194830182
Name:MIDTOWN INVESTMENTS LLC
Entity Type:Organization
Organization Name:MIDTOWN INVESTMENTS LLC
Other - Org Name:CUSTOM MEDICAL SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-842-7380
Mailing Address - Street 1:7100 NORTHLAND CIRCLE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428-1507
Mailing Address - Country:US
Mailing Address - Phone:763-535-0118
Mailing Address - Fax:763-536-0932
Practice Address - Street 1:3023 HWY 80 E
Practice Address - Street 2:SUITE A
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-3428
Practice Address - Country:US
Practice Address - Phone:601-932-1131
Practice Address - Fax:601-932-1993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS025-39706-8332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5622220004Medicare NSC