Healthcare Provider Details

I. General information

NPI: 1588754584
Provider Name (Legal Business Name): MIDWEST ANCILLARY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 RADIO DR
WOODBURY MN
55125-5805
US

IV. Provider business mailing address

215 RADIO DR STE 202
WOODBURY MN
55125-5822
US

V. Phone/Fax

Practice location:
  • Phone: 651-702-0750
  • Fax: 651-645-6166
Mailing address:
  • Phone: 651-702-0750
  • Fax: 651-645-6166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number207Y00000X
License Number StateMN

VIII. Authorized Official

Name: ANTHONY BENUSA
Title or Position: CEO
Credential:
Phone: 651-632-9701