Healthcare Provider Details

I. General information

NPI: 1770697740
Provider Name (Legal Business Name): MIDWEST HEALTH INNOVATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 MAIN ST
SCRIBNER NE
68057-3196
US

IV. Provider business mailing address

PO BOX 439
SCRIBNER NE
68057-0439
US

V. Phone/Fax

Practice location:
  • Phone: 402-664-3133
  • Fax: 402-664-3074
Mailing address:
  • Phone: 402-664-3133
  • Fax: 402-664-3074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3102
License Number StateNE

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier10026578900
Identifier TypeMEDICAID
Identifier StateNE
Identifier Issuer
# 2
Identifier2160948
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: TILLARA L KRUSE
Title or Position: VP
Credential: PHARMD
Phone: 402-664-3133