Provider Demographics
NPI:1487036141
Name:MMR MEDICAL, LLC
Entity Type:Organization
Organization Name:MMR MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:K
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-610-9877
Mailing Address - Street 1:PO BOX 190866
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-0866
Mailing Address - Country:US
Mailing Address - Phone:251-610-9877
Mailing Address - Fax:
Practice Address - Street 1:1120 HILLCREST RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-3968
Practice Address - Country:US
Practice Address - Phone:251-610-9877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies