Healthcare Provider Details

I. General information

NPI: 1508913336
Provider Name (Legal Business Name): MENTOR ABI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2408 E 81ST ST SUITE 2600
TULSA OK
74137-4200
US

IV. Provider business mailing address

4500 W COMMERCIAL DR
NORTH LITTLE ROCK AR
72116-7055
US

V. Phone/Fax

Practice location:
  • Phone: 918-477-5111
  • Fax: 918-477-5199
Mailing address:
  • Phone: 501-758-8799
  • Fax: 501-753-8204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number2371
License Number StateOK

VIII. Authorized Official

Name: CINDY A BEATY
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 501-758-8799