Healthcare Provider Details

I. General information

NPI: 1932396207
Provider Name (Legal Business Name): MID-STATE INVESTMENTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 US HIGHWAY 68 W
BENTON KY
42025-7418
US

IV. Provider business mailing address

837 US HIGHWAY 68 W
BENTON KY
42025-7418
US

V. Phone/Fax

Practice location:
  • Phone: 270-252-0897
  • Fax: 270-252-0899
Mailing address:
  • Phone: 270-252-0897
  • Fax: 270-252-0899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number169528
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number169528
License Number StateKY

VIII. Authorized Official

Name: MRS. TERI JONES
Title or Position: MANAGER
Credential:
Phone: 270-252-0897