1134185713 NPI number — MASSAC COUNTY MENTAL HEALTH & FAMILY COUNSELING CENTER INC

Table of content: WILLIAM CURTIS SMALL MD (NPI 1992793673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134185713 NPI number — MASSAC COUNTY MENTAL HEALTH & FAMILY COUNSELING CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASSAC COUNTY MENTAL HEALTH & FAMILY COUNSELING CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MASSAC COUNTY MENTAL HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134185713
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 W FIFTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
METROPOLIS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-524-9368
Provider Business Mailing Address Fax Number:
618-524-9551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 W FIFTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
METROPOLIS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-524-9368
Provider Business Practice Location Address Fax Number:
618-524-9551
Provider Enumeration Date:
04/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RATH
Authorized Official First Name:
YVONNE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
618-524-9368

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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