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General NPI Number Information
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NPI Number | 1265874648
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Entity Type | Organization
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Legal Business Name | MOMENTUM MEDICAL SERVICES, LLC
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 400 WAINWRIGHT ST
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City | WAVELAND
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State | MS
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Zip | 39576-2511
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Country | US
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Telephone | 228-263-0037
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Fax | 228-466-4925
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Provider Business Mailing Address
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Address Line | 400 WAINWRIGHT ST
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City | WAVELAND
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State | MS
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Zip | 39576-2511
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Country | US
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Telephone | 228-263-0037
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Fax | 228-466-4925
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ORTON F GRINNELL II
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Credential | CSFA/CST
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Telephone | 228-263-0037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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