Healthcare Provider Details

I. General information

NPI: 1215226931
Provider Name (Legal Business Name): MNM 1997, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12946 DAIRY ASHFORD RD SUITE 360
SUGAR LAND TX
77478-3161
US

IV. Provider business mailing address

12946 DAIRY ASHFORD RD SUITE 360
SUGAR LAND TX
77478-3161
US

V. Phone/Fax

Practice location:
  • Phone: 800-660-6064
  • Fax: 281-313-7155
Mailing address:
  • Phone: 800-660-6064
  • Fax: 281-313-7155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. RICK BARRETT
Title or Position: COO
Credential:
Phone: 281-276-1009