Healthcare Provider Details

I. General information

NPI: 1023027166
Provider Name (Legal Business Name): MIDWEST DIVISION - ACH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S 1ST ST
IOLA KS
66749-3505
US

IV. Provider business mailing address

101 S 1ST ST
IOLA KS
66749-3505
US

V. Phone/Fax

Practice location:
  • Phone: 620-365-1000
  • Fax: 620-365-1032
Mailing address:
  • Phone: 620-365-1000
  • Fax: 620-365-1032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LARRY PETERSON
Title or Position: CFO
Credential:
Phone: 620-365-1026