Provider Demographics
NPI:1114763299
Name:CM EXCAVATING, LLC
Entity type:Organization
Organization Name:CM EXCAVATING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PROSSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-339-1571
Mailing Address - Street 1:3669 METCALF RD
Mailing Address - Street 2:
Mailing Address - City:IUKA
Mailing Address - State:IL
Mailing Address - Zip Code:62849-1923
Mailing Address - Country:US
Mailing Address - Phone:618-339-1571
Mailing Address - Fax:
Practice Address - Street 1:12374 E MIDDLE RD
Practice Address - Street 2:
Practice Address - City:TEXICO
Practice Address - State:IL
Practice Address - Zip Code:62889-3400
Practice Address - Country:US
Practice Address - Phone:618-339-1571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty