Mark Slaughter PC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

MARK SLAUGHTER PC

Practice address

219 2ND Ave
Suite C
Edwardsville, IL 62025-2556

Phone

(618) 656-5433

Fax

(618) 656-5437

NPI assigned

Apr 3, 2007

Organization subpart

No

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

Authorized official

Name

Mark Slaughter, P. T.NPI 1912009739

Title

Physical Therapist Owner

Phone

(618) 656-5433

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark S Slaughter, PT

  • Physical Therapist
  • Edwardsville, IL
  • NPI 1912009739
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201824000000",
    "number": "1922129352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 2ND AVE",
            "address_2": "SUITE C",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252556",
            "telephone_number": "618-656-5433",
            "fax_number": "618-656-5437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 2ND AVE",
            "address_2": "SUITE C",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252556",
            "telephone_number": "618-656-5433",
            "fax_number": "618-656-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK SLAUGHTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2008-02-01",
        "status": "A",
        "authorized_official_last_name": "SLAUGHTER",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST  OWNER",
        "authorized_official_telephone_number": "618-656-5433",
        "authorized_official_credential": "P. T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "06032038",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4650113",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "514168",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "167276",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "64-00479",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Luke Makler, DPT
• Ada Malone
• James Maly IV, CRNA
• Hannah Maness, RN
• Srimannarayana Marella, M.D
• Holly A Martin-Fildew, COTA/L
• Andrea Michelle Martin
• Maryville Imaging, LLC
• Thomas Richard Mason, PTA
• Kayla Mast, BEHAVIOR TECHNICIAN

• Physical Therapist in Edwardsville, IL
• Providers in Edwardsville, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2008; 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.