MEDICARE: MONITORING MANAGEMENT PARTNERS MMP PLLC

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	174400000X	Specialist
2	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1871811976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONITORING MANAGEMENT PARTNERS MMP PLLC

Provider Business Mailing Address
First Line	:	1256 HIGH CREST CIR
Second Line	:
City	:	FRUIT HEIGHTS
State	:	UT
Zip	:	84037-4406
Country	:	US
Telephone Number	:	855-864-4322
Fax Number	:	866-540-2867

Provider Business Practice Location Address
First Line	:	9811 W CHARLESTON BLVD
Second Line	:	STE. 2-641
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7528
Country	:	US
Telephone Number	:	855-864-4322
Fax Number	:	866-540-2867

Authorized Official
Title or Position	:	OWNER
Name	:	MR. NICK C LUEKENGA
Credential	:
Telephone Number	:	855-864-4322

Provider Enumeration Date	:	05/13/2010
Last Update Date	:	04/08/2016

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