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Organization
MNT, INC.
Active
Organization
MNT, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS T ANDERSON (OWNER)
(270) 901-3412
Entity
Organization
Contact information
Practice address
207 TRADITIONS BLVD, BOWLING GREEN, KY 42103-7957
(270) 901-3412
(270) 901-3413
Mailing address
207 TRADITIONS BLVD, BOWLING GREEN, KY 42103-7957
(270) 901-3412
(270) 901-3413
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
KY
163W00000X
Registered Nurse
—
KY
174400000X
Specialist
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000334989
ANTHEM
KY
01
—
01256
MEDICARE P-TAN
KY
01
—
01616306
AMERIGROUP TN
TN
01
—
103G709673
MEDICARE P-TAN
TN
01
—
1526503
TENNCARE MEDICAID
TN
01
—
392072
CIGNA TN
TN
01
—
9566482
AETNA
KY
01
—
DQ0042
RAILROAD MEDICARE
KY
01
—
NONE
INTEGRATED HEALTH PLAN
KY
01
—
NONE
BLUE CROSS BLUE SHIELD TN
TN
Enumeration date
01/21/2010
Last updated
02/19/2020
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