Provider Demographics
NPI:1598018467
Name:MRSRD, LLC
Entity Type:Organization
Organization Name:MRSRD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDOE
Authorized Official - Phone:401-556-9396
Mailing Address - Street 1:PO BOX 584
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03070-0584
Mailing Address - Country:US
Mailing Address - Phone:401-556-9396
Mailing Address - Fax:603-487-1419
Practice Address - Street 1:50 EMERSON RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-3516
Practice Address - Country:US
Practice Address - Phone:401-556-9396
Practice Address - Fax:603-487-1419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0660305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service