Provider Demographics
NPI:1982834263
Name:MIDWEST HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:MIDWEST HEALTH SERVICES INC.
Other - Org Name:MIDWEST HEALTH SERVICES HOME 1
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSPEH
Authorized Official - Middle Name:
Authorized Official - Last Name:KNETZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-832-9582
Mailing Address - Street 1:11 LINCOLN WAY W
Mailing Address - Street 2:STE 5A
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44647-6585
Mailing Address - Country:US
Mailing Address - Phone:330-674-2281
Mailing Address - Fax:330-833-7732
Practice Address - Street 1:5650 TR 332 STAR RTE
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654
Practice Address - Country:US
Practice Address - Phone:330-674-2281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3810031305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2940492OtherMEDICAID VENDOR NUMBER