Provider Demographics
NPI:1629522008
Name:MGHMI
Entity Type:Organization
Organization Name:MGHMI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MOLLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-638-9817
Mailing Address - Street 1:4311 BAYOU BLVD APT A8
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2621
Mailing Address - Country:US
Mailing Address - Phone:506-299-3668
Mailing Address - Fax:866-258-9993
Practice Address - Street 1:6109 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6949
Practice Address - Country:US
Practice Address - Phone:850-741-2251
Practice Address - Fax:866-258-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty