=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386818037
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M C ENTERPRISES AND ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2008
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1216 E 7TH ST
-----------------------------------------------------
City | METROPOLIS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62960-2330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-524-3890
-----------------------------------------------------
Fax | 618-524-8164
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1216 E 7TH ST
-----------------------------------------------------
City | METROPOLIS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62960-2330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-524-3890
-----------------------------------------------------
Fax | 618-524-8164
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. MARK EDWARD CHAMBBERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 618-921-1707
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number | 6296001
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------