Healthcare Provider Details

I. General information

NPI: 1265769699
Provider Name (Legal Business Name): MIDWEST SUPPORT & INFORMATION SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 N FRANKLIN AVE
COLBY KS
67701-2329
US

IV. Provider business mailing address

640 N FRANKLIN AVE
COLBY KS
67701-2329
US

V. Phone/Fax

Practice location:
  • Phone: 785-460-1896
  • Fax: 785-460-1897
Mailing address:
  • Phone: 785-460-1896
  • Fax: 785-460-1897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number3914
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number3914
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number3914
License Number StateKS

VIII. Authorized Official

Name: MR. TERRY D DRENNER
Title or Position: DIRECTOR
Credential:
Phone: 785-460-1896