Healthcare Provider Details

I. General information

NPI: 1578902011
Provider Name (Legal Business Name): MNM ECOMMERCE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5271 MENDENHALL PARK PL
MEMPHIS TN
38115-5906
US

IV. Provider business mailing address

111 S HIGHLAND ST #179
MEMPHIS TN
38111-4640
US

V. Phone/Fax

Practice location:
  • Phone: 901-726-3966
  • Fax: 901-726-3966
Mailing address:
  • Phone:
  • Fax:

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: MRS. ANN WILLIAMS
Title or Position: DIRECTOR
Credential:
Phone: 901-726-3966