Provider Demographics
NPI:1730294737
Name:MIDTOWN INVESTMENTS LLC
Entity Type:Organization
Organization Name:MIDTOWN INVESTMENTS LLC
Other - Org Name:CUSTOM MEDICAL SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-842-7380
Mailing Address - Street 1:7100 NORTHLAND CIR N
Mailing Address - Street 2:SUITE 410
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428-1548
Mailing Address - Country:US
Mailing Address - Phone:763-535-0118
Mailing Address - Fax:612-294-3289
Practice Address - Street 1:2550 S DECKER LAKE BLVD STE 23
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-7656
Practice Address - Country:US
Practice Address - Phone:801-972-2466
Practice Address - Fax:801-972-2488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT20050170332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT=========001Medicaid