Healthcare Provider Details

I. General information

NPI: 1316924848
Provider Name (Legal Business Name): MMSC VENTURES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 S BROADWAY ST
TOLEDO IA
52342-2307
US

IV. Provider business mailing address

1307 S BROADWAY ST
TOLEDO IA
52342-2307
US

V. Phone/Fax

Practice location:
  • Phone: 641-484-4449
  • Fax:
Mailing address:
  • Phone: 641-484-4449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT B. COOPER
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential:
Phone: 641-754-5145