Provider Demographics
NPI:1477555050
Name:MIDWEST MEDICAL SUPPLY
Entity Type:Organization
Organization Name:MIDWEST MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITHCELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEINES
Authorized Official - Suffix:
Authorized Official - Credentials:RP
Authorized Official - Phone:402-223-2300
Mailing Address - Street 1:117 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-3902
Mailing Address - Country:US
Mailing Address - Phone:402-223-2300
Mailing Address - Fax:402-223-2315
Practice Address - Street 1:117 N 5TH ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-3902
Practice Address - Country:US
Practice Address - Phone:402-223-2300
Practice Address - Fax:402-223-2315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
08862OtherBLUE CROSS NEBRASKA
NE10024972500Medicaid
4809160001Medicare ID - Type Unspecified