Provider Demographics
NPI:1770697740
Name:MIDWEST HEALTH INNOVATIONS LLC
Entity type:Organization
Organization Name:MIDWEST HEALTH INNOVATIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:TILLARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:402-664-3133
Mailing Address - Street 1:PO BOX 439
Mailing Address - Street 2:
Mailing Address - City:SCRIBNER
Mailing Address - State:NE
Mailing Address - Zip Code:68057-0439
Mailing Address - Country:US
Mailing Address - Phone:402-664-3133
Mailing Address - Fax:402-664-3074
Practice Address - Street 1:416 MAIN ST
Practice Address - Street 2:
Practice Address - City:SCRIBNER
Practice Address - State:NE
Practice Address - Zip Code:68057-3196
Practice Address - Country:US
Practice Address - Phone:402-664-3133
Practice Address - Fax:402-664-3074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE31023336C0003X, 3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026578900Medicaid
2160948OtherPK
NE10025991600Medicaid