Provider Demographics
NPI:1932396207
Name:MID-STATE INVESTMENTS LLC
Entity Type:Organization
Organization Name:MID-STATE INVESTMENTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-252-0897
Mailing Address - Street 1:837 US HIGHWAY 68 W
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-7418
Mailing Address - Country:US
Mailing Address - Phone:270-252-0897
Mailing Address - Fax:270-252-0899
Practice Address - Street 1:837 US HIGHWAY 68 W
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-7418
Practice Address - Country:US
Practice Address - Phone:270-252-0897
Practice Address - Fax:270-252-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY169528332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100018430Medicaid
KY7100013200Medicaid
KY7100018430Medicaid
6017400001Medicare NSC