Provider Demographics
NPI:1225143589
Name:MEDICAL CONSULTANTS ANCILLARY SERVICES LLC
Entity Type:Organization
Organization Name:MEDICAL CONSULTANTS ANCILLARY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-281-2188
Mailing Address - Street 1:PO BOX 2218
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47307
Mailing Address - Country:US
Mailing Address - Phone:765-281-2188
Mailing Address - Fax:765-281-2062
Practice Address - Street 1:2525 UNIVERSITY AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3400
Practice Address - Country:US
Practice Address - Phone:765-281-2000
Practice Address - Fax:765-281-2062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN199430Medicare ID - Type Unspecified