Provider Demographics
NPI:1407924897
Name:MEDICAL MANAGEMENT OPTIONS, LLC
Entity Type:Organization
Organization Name:MEDICAL MANAGEMENT OPTIONS, LLC
Other - Org Name:MMO OF LAFAYETTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-293-6774
Mailing Address - Street 1:728 NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802-5724
Mailing Address - Country:US
Mailing Address - Phone:225-293-6774
Mailing Address - Fax:225-291-9229
Practice Address - Street 1:117 E. PINHOOK RD.
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501
Practice Address - Country:US
Practice Address - Phone:337-237-9180
Practice Address - Fax:337-264-1356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA28-00444454261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19-4615Medicare ID - Type Unspecified