1386818037 NPI number — M C ENTERPRISES AND ASSOCIATES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386818037 NPI number — M C ENTERPRISES AND ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M C ENTERPRISES AND ASSOCIATES
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:
Provider Other Organization Name Type Code:
6
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:
1386818037
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1216 E 7TH 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:
62960-2330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-524-3890
Provider Business Mailing Address Fax Number:
618-524-8164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1216 E 7TH 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:
62960-2330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-524-3890
Provider Business Practice Location Address Fax Number:
618-524-8164
Provider Enumeration Date:
04/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CHAMBBERS
Authorized Official First Name:
MARK
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
618-921-1707

Provider Taxonomy Codes

  • Taxonomy code: 344600000X , with the licence number:  6296001 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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