Provider Demographics
NPI:1083161970
Name:MO MEDICAL MANAGEMENT INC.
Entity Type:Organization
Organization Name:MO MEDICAL MANAGEMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:570-288-4205
Mailing Address - Street 1:675 WYOMING AVENUE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3831
Mailing Address - Country:US
Mailing Address - Phone:570-288-4205
Mailing Address - Fax:570-288-4889
Practice Address - Street 1:675 WYOMING AVENUE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3831
Practice Address - Country:US
Practice Address - Phone:570-288-4205
Practice Address - Fax:570-288-4889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty