Provider Demographics
NPI:1508913336
Name:MENTOR ABI, LLC
Entity Type:Organization
Organization Name:MENTOR ABI, LLC
Other - Org Name:OKLAHOMA NEUROSPECIALTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-758-8799
Mailing Address - Street 1:4500 W COMMERCIAL DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7055
Mailing Address - Country:US
Mailing Address - Phone:501-758-8799
Mailing Address - Fax:501-753-8204
Practice Address - Street 1:2408 E 81ST ST
Practice Address - Street 2:SUITE 2600
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4200
Practice Address - Country:US
Practice Address - Phone:918-477-5111
Practice Address - Fax:918-477-5199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2371284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2371OtherGEN MEDSURG HOSPITAL
OK2371OtherGEN MEDSURG HOSPITAL
OKFO0100420OtherDEA