Provider Demographics
NPI:1578096921
Name:MID-STATE HEALTH NETWORK
Entity Type:Organization
Organization Name:MID-STATE HEALTH NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-253-7525
Mailing Address - Street 1:530 W IONIA ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48933-1062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:530 W IONIA ST
Practice Address - Street 2:SUITE F
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48933-1062
Practice Address - Country:US
Practice Address - Phone:517-253-7525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2813625Medicaid