NPIMap

Organization Active NPI

Tazwood Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Eureka, IL
National Provider Identifier
1134464316
Registry record updated Jul 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
TAZWOOD MENTAL HEALTH CENTER, INC.
Practice address
101 S. Major Street
Eureka, IL 61530
Phone
(309) 694-6462
Fax
(309) 347-4264
NPI assigned
Nov 29, 2012
Last updated
Jul 12, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. David W. Mingus, LCPC, CRADC
Title
Ceo
Phone
(309) 347-5522

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

101 S. Major Street
Eureka, IL 61530

Mailing address

3248 Vandever Ave
Pekin, IL 61554-6257
Phone (309) 347-5522

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040108000963 IL Part B Supplier - Clinic/Group Practice 1850291741 Receives reassigned benefits from 18 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: East Peoria, IL; Eureka, IL; Pekin, IL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Tazwood Mental Health Center Inc14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

100 N Main St
Ste 100
East Peoria, IL 61611
Phone (309) 694-6462

111 W Washington St
East Peoria, IL 61611
Phone (309) 694-6462

109 E Eureka Ave
Eureka, IL 61530
Phone (309) 467-3770

1831 S Main St
Eureka, IL 61530
Phone (309) 347-5522

1618 Valle Vista Blvd
Pekin, IL 61554
Phone (309) 347-1634

3248 Vandever Ave
Ste A
Pekin, IL 61554
Phone (309) 347-5522

3249 Barney Ave
Pekin, IL 61554
Phone (309) 347-5522

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1354147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531353600000",
    "number": "1134464316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3248 VANDEVER AVE",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615546257",
            "telephone_number": "309-347-5522",
            "fax_number": "309-347-4264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S. MAJOR STREET",
            "city": "EUREKA",
            "state": "IL",
            "postal_code": "61530",
            "telephone_number": "309-694-6462",
            "fax_number": "309-347-4264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAZWOOD MENTAL HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-29",
        "last_updated": "2018-07-12",
        "status": "A",
        "authorized_official_last_name": "MINGUS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "309-347-5522",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCPC, CRADC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eureka, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.