Provider Demographics
NPI:1215230495
Name:MBS ENVISION, INC
Entity Type:Organization
Organization Name:MBS ENVISION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAZZOLLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-923-3502
Mailing Address - Street 1:2707 COUNTY ROAD 350 E
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-9734
Mailing Address - Country:US
Mailing Address - Phone:217-897-6655
Mailing Address - Fax:217-897-6999
Practice Address - Street 1:2707 COUNTY ROAD 350 E
Practice Address - Street 2:
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-9734
Practice Address - Country:US
Practice Address - Phone:217-897-6655
Practice Address - Fax:217-897-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty