The Metro Mentorship Initiative

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

Legal business name

THE METRO MENTORSHIP INITIATIVE

Practice address

1828 N Lowell Ave
Chicago, IL 60639-4818

Phone

(773) 595-4645

NPI assigned

Mar 29, 2016

Organization subpart

No

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

Authorized official

Name

Lorne Massie

Title

President

Phone

(773) 595-4645

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1459209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459209600000",
    "number": "1417310335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1828 N LOWELL AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606394818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1828 N LOWELL AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606394818",
            "telephone_number": "773-595-4645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE METRO MENTORSHIP INITIATIVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-29",
        "last_updated": "2016-03-29",
        "status": "A",
        "authorized_official_last_name": "MASSIE",
        "authorized_official_first_name": "LORNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-595-4645"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Preferred Provider Organization in Chicago, IL
• Providers in Chicago, IL by specialty
• Preferred Provider Organization in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.