Provider Demographics
NPI:1114122587
Name:MMDS INTERNATIONAL LLC
Entity Type:Organization
Organization Name:MMDS INTERNATIONAL LLC
Other - Org Name:MMDS INTERNATIONAL LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-903-6796
Mailing Address - Street 1:PO BOX 701
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30722-0701
Mailing Address - Country:US
Mailing Address - Phone:706-271-0055
Mailing Address - Fax:706-270-0487
Practice Address - Street 1:845 DUFF PATT HIGHWAY
Practice Address - Street 2:
Practice Address - City:DUFFIELD
Practice Address - State:VA
Practice Address - Zip Code:24244-0584
Practice Address - Country:US
Practice Address - Phone:706-271-0055
Practice Address - Fax:706-270-0487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========00OtherJOHN DEERE UNITED HEALTHC
VA499816Medicare ID - Type UnspecifiedTRAILBLAZER HEALTH