Provider Demographics
NPI:1891744215
Name:MID-CENTRAL MEDICAL INC
Entity Type:Organization
Organization Name:MID-CENTRAL MEDICAL INC
Other - Org Name:AMERICAN MEDICAL SUPPLY AND SERVICE CO.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BURTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-965-3734
Mailing Address - Street 1:281 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:VIRDEN
Mailing Address - State:IL
Mailing Address - Zip Code:62690-1451
Mailing Address - Country:US
Mailing Address - Phone:217-965-3734
Mailing Address - Fax:217-965-3371
Practice Address - Street 1:281 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:VIRDEN
Practice Address - State:IL
Practice Address - Zip Code:62690-1451
Practice Address - Country:US
Practice Address - Phone:217-965-3734
Practice Address - Fax:217-965-3371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203.000130332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1696366Medicaid
KY90212333Medicaid
MO626170807Medicaid
KS200334860AMedicaid
TN4581903Medicaid
IL=========001Medicaid
TN4581903Medicaid