Provider Demographics
NPI:1962685131
Name:SLINGSHOT MTM INC
Entity Type:Organization
Organization Name:SLINGSHOT MTM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDRA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:888-801-1438
Mailing Address - Street 1:1105 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-0758
Mailing Address - Country:US
Mailing Address - Phone:888-801-1438
Mailing Address - Fax:888-801-1438
Practice Address - Street 1:1105 MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-0758
Practice Address - Country:US
Practice Address - Phone:888-801-1438
Practice Address - Fax:888-801-1438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management