Provider Demographics
NPI:1437136165
Name:MMSC VENTURES INC
Entity Type:Organization
Organization Name:MMSC VENTURES INC
Other - Org Name:CONRAD FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-754-5145
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:CONRAD
Mailing Address - State:IA
Mailing Address - Zip Code:50621-0040
Mailing Address - Country:US
Mailing Address - Phone:641-366-2123
Mailing Address - Fax:
Practice Address - Street 1:105 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:CONRAD
Practice Address - State:IA
Practice Address - Zip Code:50621-7714
Practice Address - Country:US
Practice Address - Phone:641-366-2123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MMSC VENTURES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-23
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0634212Medicaid
IA163421Medicare Oscar/Certification