Provider Demographics
NPI:1588754584
Name:MIDWEST ANCILLARY SERVICES, INC
Entity type:Organization
Organization Name:MIDWEST ANCILLARY SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KARLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-702-0750
Mailing Address - Street 1:2080 WOODWINDS DR
Mailing Address - Street 2:#240
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2523
Mailing Address - Country:US
Mailing Address - Phone:651-702-0750
Mailing Address - Fax:651-645-6166
Practice Address - Street 1:217 RADIO DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-5805
Practice Address - Country:US
Practice Address - Phone:651-702-0750
Practice Address - Fax:651-645-6166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN207Y00000X332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN005210800Medicaid