Provider Demographics
NPI:1578902011
Name:MNM ECOMMERCE GROUP, LLC
Entity Type:Organization
Organization Name:MNM ECOMMERCE GROUP, LLC
Other - Org Name:C/O MEDICAL CRANIAL PROSTHESIS DIVISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-726-3966
Mailing Address - Street 1:111 S HIGHLAND ST
Mailing Address - Street 2:#179
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5271 MENDENHALL PARK PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-5906
Practice Address - Country:US
Practice Address - Phone:901-726-3966
Practice Address - Fax:901-726-3966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier