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General NPI Number Information
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NPI Number | 1649089418
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Entity Type | Organization
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Legal Business Name | MNR INDUSTRIES, LLC
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 2699 TOBIN CROSSING SUITE 1 & 2
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City | BEL AIR
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State | MD
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Zip | 21015
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Country | US
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Telephone | 667-925-0778
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Fax | 667-925-0791
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Provider Business Mailing Address
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Address Line | 1505 E CHURCHVILLE RD
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City | BEL AIR
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State | MD
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Zip | 21014-4742
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Country | US
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Telephone | 410-420-6970
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Fax | 410-420-6650
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Authorized Official
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Title or Position | MANAGER OF CREDENTIALING
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Name | TAVIANNA BOST
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Credential |
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Telephone | 410-420-6970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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