Provider Demographics
NPI:1215226931
Name:MNM 1997, INC
Entity Type:Organization
Organization Name:MNM 1997, INC
Other - Org Name:STARDENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-276-1009
Mailing Address - Street 1:12946 DAIRY ASHFORD RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3161
Mailing Address - Country:US
Mailing Address - Phone:800-660-6064
Mailing Address - Fax:281-313-7155
Practice Address - Street 1:12946 DAIRY ASHFORD RD
Practice Address - Street 2:SUITE 360
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3161
Practice Address - Country:US
Practice Address - Phone:800-660-6064
Practice Address - Fax:281-313-7155
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST CONTINENTAL LIFE & ACCIDENT INSURANCE COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization