Healthcare Provider Details

I. General information

NPI: 1275743791
Provider Name (Legal Business Name): MMC OF NEVADA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 BERTHA HOWE AVE
MESQUITE NV
89027-7500
US

IV. Provider business mailing address

PO BOX 847743
DALLAS TX
75284-7743
US

V. Phone/Fax

Practice location:
  • Phone: 702-346-7037
  • Fax: 702-346-7031
Mailing address:
  • Phone: 702-346-7037
  • Fax: 702-346-7031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: RANDY MICHAEL COOPER
Title or Position: SVP FINANCE OP/AUTHORIZED OFFICIAL
Credential:
Phone: 615-221-3840