MEDICARE: MMM MEDICAL MARKETING & MANAGEMENT, 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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1710341938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MMM MEDICAL MARKETING & MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	4054 DEAN MARTIN DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4195
Country	:	US
Telephone Number	:	303-667-2301
Fax Number	:	888-510-9071

Provider Business Practice Location Address
First Line	:	4054 DEAN MARTIN DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4195
Country	:	US
Telephone Number	:	303-667-2301
Fax Number	:	888-510-9071

Authorized Official
Title or Position	:	CEO
Name	:	MISS RONALD GORSCHE
Credential	:
Telephone Number	:	303-667-2301

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	04/13/2016

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