Provider Demographics
NPI:1053429225
Name:MICOR ENTERPRISES INC
Entity type:Organization
Organization Name:MICOR ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLUETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-752-1553
Mailing Address - Street 1:2401 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-4402
Mailing Address - Country:US
Mailing Address - Phone:641-752-1553
Mailing Address - Fax:641-728-2429
Practice Address - Street 1:2401 S 2ND ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-4402
Practice Address - Country:US
Practice Address - Phone:641-752-1553
Practice Address - Fax:641-728-2429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAN-803314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0807305Medicaid
IA165451Medicare Oscar/Certification