Provider Demographics
NPI:1881925428
Name:MNT, INC.
Entity type:Organization
Organization Name:MNT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-901-3412
Mailing Address - Street 1:207 TRADITIONS BLVD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7957
Mailing Address - Country:US
Mailing Address - Phone:270-901-3412
Mailing Address - Fax:270-901-3413
Practice Address - Street 1:207 TRADITIONS BLVD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7957
Practice Address - Country:US
Practice Address - Phone:270-901-3412
Practice Address - Fax:270-901-3413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY163W00000X, 174400000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN392072OtherCIGNA TN
KYNONEOtherINTEGRATED HEALTH PLAN
TN103G709673OtherMEDICARE P-TAN
KY9566482OtherAETNA
TNNONEOtherBLUE CROSS BLUE SHIELD TN
KYNONEOtherHUMANA KY
KY000000334989OtherANTHEM
TN01616306OtherAMERIGROUP TN
TN1526503OtherTENNCARE MEDICAID
KYNONEOtherBLUEGRASS FAMILY HEALTH
KYNONEOtherOPTUM HEALTH
KY01256OtherMEDICARE P-TAN
KYDQ0042OtherRAILROAD MEDICARE