Healthcare Provider Details

I. General information

NPI: 1558970087
Provider Name (Legal Business Name): MBS ENVISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E MAIN ST STE 101
MAHOMET IL
61853-7460
US

IV. Provider business mailing address

11350 TOMAHAWK CREEK PKWY STE 100
LEAWOOD KS
66211-2617
US

V. Phone/Fax

Practice location:
  • Phone: 913-359-6001
  • Fax:
Mailing address:
  • Phone: 913-359-6021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: CORREY TRUPP
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 913-233-6307