Healthcare Provider Details

I. General information

NPI: 1518651686
Provider Name (Legal Business Name): MNM MEDICAL TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N HWY 360 SUITE 2007B PMB 1012 2007B PMB1012
GRAND PRAIRIE TX
75050
US

IV. Provider business mailing address

2100 N HWY 360 SUITE 2007B PMB 1012 2007B PMB1012
GRAND PRAIRIE TX
75050
US

V. Phone/Fax

Practice location:
  • Phone: 469-588-6993
  • Fax:
Mailing address:
  • Phone: 469-588-6993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MARSHA L MCKINLEY
Title or Position: MANAGER
Credential:
Phone: 469-588-6993