Healthcare Provider Details

I. General information

NPI: 1861263287
Provider Name (Legal Business Name): MENM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 E JOYCE BLVD STE 2
FAYETTEVILLE AR
72703-5135
US

IV. Provider business mailing address

8300 CENTRAL PARK DR STE 100
WACO TX
76712-6666
US

V. Phone/Fax

Practice location:
  • Phone: 479-443-6511
  • Fax:
Mailing address:
  • Phone: 254-227-6825
  • Fax: 254-300-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: NIDIA GARCIA
Title or Position: VP OF MARKETING
Credential:
Phone: 254-227-6825