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General NPI Number Information
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NPI Number | 1962685131
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Entity Type | Organization
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Legal Business Name | SLINGSHOT MTM INC
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 1105 MOUNTAIN VIEW DR
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City | JOLIET
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State | IL
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Zip | 60432-0758
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Country | US
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Telephone | 888-801-1438
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Fax | 888-801-1438
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Provider Business Mailing Address
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Address Line | 1105 MOUNTAIN VIEW DR
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City | JOLIET
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State | IL
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Zip | 60432-0758
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Country | US
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Telephone | 888-801-1438
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Fax | 888-801-1438
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAY MANDRA
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Credential | PHARMD
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Telephone | 888-801-1438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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