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General NPI Number Information
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NPI Number | 1558970087
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Entity Type | Organization
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Legal Business Name | MBS ENVISION LLC
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Dates
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Enumeration Date | 07/30/2020
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Last Update Date | 07/30/2020
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Provider Practice Location Address
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Address Line | 601 E MAIN ST STE 101
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City | MAHOMET
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State | IL
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Zip | 61853-7460
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Country | US
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Telephone | 913-359-6001
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Fax |
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Provider Business Mailing Address
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Address Line | 11350 TOMAHAWK CREEK PKWY STE 100
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City | LEAWOOD
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State | KS
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Zip | 66211-2617
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Country | US
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Telephone | 913-359-6021
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | CORREY TRUPP
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Credential |
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Telephone | 913-233-6307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235500000X
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Taxonomy Name | Speech/Language/Hearing Specialist/Technologist
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License Number |
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License Number State |
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