Provider Demographics
NPI:1891771663
Name:MMSC VENTURES INC
Entity Type:Organization
Organization Name:MMSC VENTURES INC
Other - Org Name:STATE CENTER FAMILY MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOWNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-754-5125
Mailing Address - Street 1:3 SOUTH 4TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-2998
Mailing Address - Country:US
Mailing Address - Phone:641-754-5151
Mailing Address - Fax:641-754-5181
Practice Address - Street 1:503 3RD AVE SW
Practice Address - Street 2:
Practice Address - City:STATE CENTER
Practice Address - State:IA
Practice Address - Zip Code:50247-7719
Practice Address - Country:US
Practice Address - Phone:641-483-2141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MMSC VENTURES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-22
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0685214Medicaid
IA47411OtherBLUE SHIELD OF IOWA
IA47411OtherBLUE SHIELD OF IOWA