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General NPI Number Information
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NPI Number | 1669963773
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Entity Type | Organization
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Legal Business Name | MEDMOCO, LLC
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Dates
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Enumeration Date | 05/24/2018
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 155 E MAIN ST
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City | MCCONNELSVILLE
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State | OH
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Zip | 43756-1296
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Country | US
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Telephone | 740-517-0076
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Fax |
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Provider Business Mailing Address
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Address Line | 314 S STATE ROUTE 376 SE
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City | MCCONNELSVILLE
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State | OH
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Zip | 43756-9631
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Country | US
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Telephone | 740-517-0076
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Fax |
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Authorized Official
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Title or Position | FNP
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Name | MS. TAMMY IRENE MORROW
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Credential | FNP
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Telephone | 740-517-0076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | APRN.CNP.13117
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License Number State | OH
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