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General NPI Number Information
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NPI Number | 1912924630
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Entity Type | Organization
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Legal Business Name | MEDICAL INCOME MANAGEMENT CORP
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 04/24/2009
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Provider Practice Location Address
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Address Line | 101 W JEFFERSON ST
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City | SULLIVAN
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State | IL
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Zip | 61951-1914
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Country | US
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Telephone | 217-728-9999
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1215
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City | MATTOON
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State | IL
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Zip | 61938-1215
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KURT M DEARNBARGER
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Credential | MD
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Telephone | 217-728-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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