Provider Demographics
NPI:1891769147
Name:MIDWEST MEDICAL, INC.
Entity Type:Organization
Organization Name:MIDWEST MEDICAL, INC.
Other - Org Name:MIDWEST MEDICAL SERVICES, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-882-4210
Mailing Address - Street 1:615 6TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-4926
Mailing Address - Country:US
Mailing Address - Phone:605-882-4210
Mailing Address - Fax:605-882-4211
Practice Address - Street 1:615 6TH ST SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-4926
Practice Address - Country:US
Practice Address - Phone:605-882-4210
Practice Address - Fax:605-882-4211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2998OtherAVERA HEALTH PLAN
SD9162540Medicaid
SD2482OtherSIOUX VALLEY HEALTH PLAN
SD0077352OtherBLUE CROSS/ BLUE SHIELD
MN447563100Medicaid
SD2482OtherSIOUX VALLEY HEALTH PLAN