Healthcare Provider Details

I. General information

NPI: 1164827663
Provider Name (Legal Business Name): MNR INDUSTRIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 06/23/2024
Certification Date: 06/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 BALTIMORE AVENUE SUITE 108
LAUREL MD
20707
US

IV. Provider business mailing address

1505 E CHURCHVILLE RD
BEL AIR MD
21014-4742
US

V. Phone/Fax

Practice location:
  • Phone: 301-383-0330
  • Fax:
Mailing address:
  • Phone: 410-420-6970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVEN FISHER
Title or Position: DIRECTOR, REVENUE CYCLE
Credential:
Phone: 410-420-6970