1881925428 NPI number — MNT, INC.

Table of content: (NPI 1881925428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881925428 NPI number — MNT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MNT, 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:
Provider Other Organization Name Type Code:
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:
1881925428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 TRADITIONS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWLING GREEN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42103-7957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-901-3412
Provider Business Mailing Address Fax Number:
270-901-3413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 TRADITIONS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOWLING GREEN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42103-7957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-901-3412
Provider Business Practice Location Address Fax Number:
270-901-3413
Provider Enumeration Date:
01/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
270-901-3412

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 392072 . This is a "CIGNA TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: NONE . This is a "INTEGRATED HEALTH PLAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 103G709673 . This is a "MEDICARE P-TAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 9566482 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: NONE . This is a "BLUE CROSS BLUE SHIELD TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: NONE . This is a "HUMANA KY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000334989 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 01616306 . This is a "AMERIGROUP TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1526503 . This is a "TENNCARE MEDICAID" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: NONE . This is a "BLUEGRASS FAMILY HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: NONE . This is a "OPTUM HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 01256 . This is a "MEDICARE P-TAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: DQ0042 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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