Healthcare Provider Details

I. General information

NPI: 1942284583
Provider Name (Legal Business Name): M&M ORTHOTIC & PROSTHETIC CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3061 S MARYLAND PKWY SUITE 103
LAS VEGAS NV
89109-2298
US

IV. Provider business mailing address

3061 S MARYLAND PKWY SUITE 103
LAS VEGAS NV
89109-2298
US

V. Phone/Fax

Practice location:
  • Phone: 702-992-1200
  • Fax: 702-992-1205
Mailing address:
  • Phone: 702-992-1200
  • Fax: 702-992-1205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. KRIS MADSEN
Title or Position: OWNER PRESIDENT
Credential:
Phone: 702-992-1200