1760218374 NPI number — MNT ASSOCIATES LLC

Table of content: (NPI 1760218374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760218374 NPI number — MNT ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MNT ASSOCIATES LLC
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:
1760218374
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1623 OLYMPIC DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGVIEW
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75605-2748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-290-5396
Provider Business Mailing Address Fax Number:
903-205-8541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
606 S SEVEN POINTS DR STE 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEVEN POINTS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75143-9117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-432-5633
Provider Business Practice Location Address Fax Number:
903-205-8541
Provider Enumeration Date:
09/10/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCKINNEY
Authorized Official First Name:
KATHRYN
Authorized Official Middle Name:
MAY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
903-918-0120

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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