Provider Demographics
NPI:1245462688
Name:MIDWEST THERAPY ASSOCIATES, INC.
Entity type:Organization
Organization Name:MIDWEST THERAPY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-299-9337
Mailing Address - Street 1:3122 WILMINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-4004
Mailing Address - Country:US
Mailing Address - Phone:937-299-9337
Mailing Address - Fax:937-299-9227
Practice Address - Street 1:3122 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4004
Practice Address - Country:US
Practice Address - Phone:937-299-9337
Practice Address - Fax:937-299-9227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-19
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2955628Medicaid
OH2955628Medicaid