1669746038 NPI number — MENTOR ABI, LLC D/B/A NEURORESTORATIVE INDIANA

Table of content: MRS. MONICA RENEE MCGEE RN, CCM (NPI 1457006553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669746038 NPI number — MENTOR ABI, LLC D/B/A NEURORESTORATIVE INDIANA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MENTOR ABI, LLC D/B/A NEURORESTORATIVE INDIANA
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:
1669746038
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2825
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARBONDALE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62902-2825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-529-3060
Provider Business Mailing Address Fax Number:
618-529-8119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 S ARLINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46203-5005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-529-3060
Provider Business Practice Location Address Fax Number:
618-529-8119
Provider Enumeration Date:
03/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMSON
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL VP FOR THE CENTRAL DIV
Authorized Official Telephone Number:
618-529-3060

Provider Taxonomy Codes

  • Taxonomy code: 283X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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