Provider Demographics
NPI:1275070419
Name:MID STAR LAB INC
Entity Type:Organization
Organization Name:MID STAR LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DEVELOPMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:BOCO
Authorized Official - Phone:605-377-7111
Mailing Address - Street 1:1701 COMMERCE RD
Mailing Address - Street 2:
Mailing Address - City:TONGANOXIE
Mailing Address - State:KS
Mailing Address - Zip Code:66086-5369
Mailing Address - Country:US
Mailing Address - Phone:913-369-8734
Mailing Address - Fax:
Practice Address - Street 1:708 S ROOSEVELT ST
Practice Address - Street 2:STE 2
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-0300
Practice Address - Country:US
Practice Address - Phone:605-252-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier