=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699853135
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M&M MEDICAL SUPPLY,INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3113 W MARSHALL ST SUITE 2C
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23230-4730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-539-3082
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3113 W MARSHALL ST SUITE 2C
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23230-4730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-539-3082
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOHN A MANNING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-539-3082
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 9102809
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------