Provider Demographics
NPI:1497230189
Name:MAMM ENTERPRISES, LLC
Entity Type:Organization
Organization Name:MAMM ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COSGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-677-9809
Mailing Address - Street 1:2202 BIG COVE RD SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-1348
Mailing Address - Country:US
Mailing Address - Phone:256-677-9809
Mailing Address - Fax:888-981-9347
Practice Address - Street 1:927 FRANKLIN ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4306
Practice Address - Country:US
Practice Address - Phone:256-327-7463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty