Provider Demographics
NPI:1194722215
Name:MIDWEST MEDICAL SUPPLY CORP.
Entity type:Organization
Organization Name:MIDWEST MEDICAL SUPPLY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOX
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:440-617-2113
Mailing Address - Street 1:24340 SPERRY DR
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1565
Mailing Address - Country:US
Mailing Address - Phone:440-835-0660
Mailing Address - Fax:440-835-2029
Practice Address - Street 1:24340 SPERRY DR
Practice Address - Street 2:1ST FLOOR
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1565
Practice Address - Country:US
Practice Address - Phone:440-835-0660
Practice Address - Fax:440-835-2029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18481231332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0396300001Medicare NSC