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General NPI Number Information
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NPI Number | 1932910221
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Entity Type | Organization
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Legal Business Name | MIMSHACK INC
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 5457 TWIN KNOLLS ROAD 300, #1194
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City | COLUMBIA
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State | MD
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Zip | 21045
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Country | US
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Telephone | 630-885-1552
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Fax |
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Provider Business Mailing Address
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Address Line | 5457 TWIN KNOLLS ROAD 300, #1194
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City | COLUMBIA
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State | MD
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Zip | 21045
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Country | US
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Telephone | 630-885-1552
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Fax |
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Authorized Official
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Title or Position | NP
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Name | ABENAA ASIAMA
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Credential | NP
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Telephone | 630-885-1552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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