Healthcare Provider Details

I. General information

NPI: 1598410037
Provider Name (Legal Business Name): ZACHARY MILLS RSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 BROADWAY AVE E
MATTOON IL
61938-4610
US

IV. Provider business mailing address

750 BROADWAY AVE E
MATTOON IL
61938-4610
US

V. Phone/Fax

Practice location:
  • Phone: 217-238-5700
  • Fax:
Mailing address:
  • Phone: 217-238-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: