Mackenzie D Flahaut

Key facts

NPI

1053071902

Entity type

Individual (NPI type 1)

Primary specialty

Attendant Care Provider 3747A0650X

Practice address

405 S Main St
Belle Rive, IL 62810-1228

Phone

(618) 316-1626

NPI assigned

Dec 20, 2021

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 20, 2021.

{
    "created_epoch": "1639958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639958400000",
    "number": "1053071902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16680 N MILLIKIN LN",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628647925",
            "telephone_number": "689-239-1432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 S MAIN ST",
            "city": "BELLE RIVE",
            "state": "IL",
            "postal_code": "628101228",
            "telephone_number": "618-316-1626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLAHAUT",
        "first_name": "MACKENZIE",
        "middle_name": "D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-20",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747A0650X",
            "taxonomy_group": "",
            "desc": "Technician, Attendant Care Provider",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Belle Rive, IL · Attendant Care Provider in Illinois