MEDICARE: MEDICAL MANAGEMENT OPTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	2791	LA

General Provider Information

NPI Number	:	1104901701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL MANAGEMENT OPTIONS, LLC

Provider Business Mailing Address
First Line	:	728 NORTH BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70802-5724
Country	:	US
Telephone Number	:	225-293-6774
Fax Number	:	225-291-9299

Provider Business Practice Location Address
First Line	:	4428 NORTH BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-3917
Country	:	US
Telephone Number	:	225-267-6443
Fax Number	:	225-346-0157

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. ROBERT L. MILLER
Credential	:
Telephone Number	:	225-293-6774

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	09/07/2011

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