Healthcare Provider Details

I. General information

NPI: 1932327053
Provider Name (Legal Business Name): M R MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 02/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 OHIO AVE
PALM HARBOR FL
34683-4417
US

IV. Provider business mailing address

344 LIAM AVENUE
TARPON SPRINGS FL
34689
US

V. Phone/Fax

Practice location:
  • Phone: 866-945-0434
  • Fax: 727-785-6128
Mailing address:
  • Phone: 866-945-0434
  • Fax: 727-785-6128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPED77
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPED77
License Number StateFL

VIII. Authorized Official

Name: JULIE MUELLER
Title or Position: PRESIDENT
Credential:
Phone: 727-224-8698