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General NPI Number Information
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NPI Number | 1063884146
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Entity Type | Organization
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Legal Business Name | MMI SCRIPT HUB & MEDICAL SUPPLIES
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Dates
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Enumeration Date | 10/28/2015
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Last Update Date | 04/17/2018
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Provider Practice Location Address
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Address Line | 1768 STORRS RD
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City | STORRS
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State | CT
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Zip | 06268-1260
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Country | US
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Telephone | 860-477-0961
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Fax | 860-477-0962
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Provider Business Mailing Address
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Address Line | 48A MOOSUP VALLEY ROAD
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City | FOSTER
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State | RI
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Zip | 02825-1236
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Country | US
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Telephone | 401-397-6203
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Fax | 401-397-8559
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Authorized Official
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Title or Position | CEO
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Name | RICKY MCCULLOUGH
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Credential |
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Telephone | 860-477-0961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD06257
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License Number State | RI
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Taxonomy #6
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Taxonomy Code | 125Q00000X
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Taxonomy Name | Oral Medicine Dentistry
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 52697
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License Number State | MA
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Taxonomy #8
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | MD06257
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License Number State | RI
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