Healthcare Provider Details

I. General information

NPI: 1821811977
Provider Name (Legal Business Name): MBBG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 WHITESPORT CIR SW STE 210
HUNTSVILLE AL
35801-7420
US

IV. Provider business mailing address

4810 WHITESPORT CIR SW
HUNTSVILLE AL
35801-7419
US

V. Phone/Fax

Practice location:
  • Phone: 256-429-4034
  • Fax:
Mailing address:
  • Phone: 702-271-8476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA MUSIC
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 615-465-7377