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General NPI Number Information
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NPI Number | 1578902011
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Entity Type | Organization
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Legal Business Name | MNM ECOMMERCE GROUP, LLC
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Dates
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Enumeration Date | 06/18/2013
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Last Update Date | 07/12/2013
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Provider Practice Location Address
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Address Line | 5271 MENDENHALL PARK PL
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City | MEMPHIS
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State | TN
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Zip | 38115-5906
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Country | US
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Telephone | 901-726-3966
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Fax | 901-726-3966
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Provider Business Mailing Address
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Address Line | 111 S HIGHLAND ST #179
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City | MEMPHIS
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State | TN
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Zip | 38111-4640
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. ANN WILLIAMS
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Credential |
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Telephone | 901-726-3966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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