Healthcare Provider Details

I. General information

NPI: 1912924630
Provider Name (Legal Business Name): MEDICAL INCOME MANAGEMENT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W JEFFERSON ST
SULLIVAN IL
61951-1914
US

IV. Provider business mailing address

PO BOX 1215
MATTOON IL
61938-1215
US

V. Phone/Fax

Practice location:
  • Phone: 217-728-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KURT M DEARNBARGER
Title or Position: OWNER
Credential: MD
Phone: 217-728-9999