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General NPI Number Information
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NPI Number | 1437136165
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Entity Type | Organization
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Legal Business Name | MMSC VENTURES INC
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Dates
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Enumeration Date | 12/23/2005
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Last Update Date | 12/03/2008
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Provider Practice Location Address
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Address Line | 105 N CHURCH ST
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City | CONRAD
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State | IA
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Zip | 50621-7714
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Country | US
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Telephone | 641-366-2123
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 40
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City | CONRAD
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State | IA
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Zip | 50621-0040
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Country | US
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Telephone | 641-366-2123
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CHIEF EXECUTIVE OFFICER
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Name | MR. ROBERT B. COOPER
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Credential |
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Telephone | 641-754-5145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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