=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851790489
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MITCHELL SNELL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2014
-----------------------------------------------------
Last Update Date | 08/20/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1592 N 146TH RD
-----------------------------------------------------
City | CONCORDIA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66901-6894
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-243-5026
-----------------------------------------------------
Fax | 785-243-5026
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 274
-----------------------------------------------------
City | CONCORDIA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66901-0274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-243-5026
-----------------------------------------------------
Fax | 785-243-5026
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171WH0202X
-----------------------------------------------------
Taxonomy Name | Home Modifications Contractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------