Provider Demographics
NPI:1982878252
Name:MIDWEST ACADEMY
Entity Type:Organization
Organization Name:MIDWEST ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-524-3560
Mailing Address - Street 1:2416 340TH ST
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-9539
Mailing Address - Country:US
Mailing Address - Phone:319-524-3560
Mailing Address - Fax:
Practice Address - Street 1:2416 340TH ST
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-9539
Practice Address - Country:US
Practice Address - Phone:319-524-3560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty