MEDICARE: LDMNUTRITION, 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	261QX0200X	Oncology Clinic/Center
2	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1902446321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LDMNUTRITION, LLC

Provider Business Mailing Address
First Line	:	7602 WHISPERING OAKS DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-5935
Country	:	US
Telephone Number	:	512-565-0671
Fax Number	:

Provider Business Practice Location Address
First Line	:	4130 SPICEWOOD SPRINGS RD STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8657
Country	:	US
Telephone Number	:	512-565-0671
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LINDSEY MENGE
Credential	:	MS, RD, LD
Telephone Number	:	512-565-0671

Provider Enumeration Date	:	01/14/2020
Last Update Date	:	01/14/2020

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Directions to “LDMNUTRITION, LLC ” Practice Location

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