Provider Demographics
NPI:1285060962
Name:CENTRAL STATE SERVICES INC
Entity type:Organization
Organization Name:CENTRAL STATE SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRECHEISEN
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:316-613-3989
Mailing Address - Street 1:1606 E WATERMAN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-1828
Mailing Address - Country:US
Mailing Address - Phone:316-613-3989
Mailing Address - Fax:316-613-3893
Practice Address - Street 1:231 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-4011
Practice Address - Country:US
Practice Address - Phone:580-242-5555
Practice Address - Fax:580-242-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2451332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment