Provider Demographics
NPI:1073950291
Name:MMI HOLDINGS LLC
Entity Type:Organization
Organization Name:MMI HOLDINGS LLC
Other - Org Name:MEDICAL MODALITIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-932-8885
Mailing Address - Street 1:325 MCGILL AVE NW
Mailing Address - Street 2:SUITE 195
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-6181
Mailing Address - Country:US
Mailing Address - Phone:704-932-8885
Mailing Address - Fax:
Practice Address - Street 1:3900 BRISTOL HWY
Practice Address - Street 2:SUITE 11
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1378
Practice Address - Country:US
Practice Address - Phone:423-610-0202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01103332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5609160002Medicare NSC