Mid-Central Medical Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

203.000130 Issued in IL

Legal business name

MID-CENTRAL MEDICAL INC

Practice address

281 E Jackson St
Virden, IL 62690-1451

Phone

(217) 965-3734

Fax

(217) 965-3371

NPI assigned

May 10, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Karen Marie Burtle

Title

President

Phone

(217) 965-3734

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• American Medical Supply and Service Co. Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335312000000",
    "number": "1891744215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "281 E JACKSON ST",
            "city": "VIRDEN",
            "state": "IL",
            "postal_code": "626901451",
            "telephone_number": "217-965-3734",
            "fax_number": "217-965-3371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "281 E JACKSON ST",
            "city": "VIRDEN",
            "state": "IL",
            "postal_code": "626901451",
            "telephone_number": "217-965-3734",
            "fax_number": "217-965-3371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-CENTRAL MEDICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2012-04-25",
        "status": "A",
        "authorized_official_last_name": "BURTLE",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-965-3734",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "203.000130",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1696366",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "90212333",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "626170807",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200334860A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4581903",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "American Medical Supply and Service Co.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Virden, IL
• Durable Medical Equipment & Medical Supplies in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.