Provider Demographics
NPI:1639278583
Name:MMDS, LLC
Entity Type:Organization
Organization Name:MMDS, LLC
Other - Org Name:STAT XRAYS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-863-0827
Mailing Address - Street 1:PO BOX 1109
Mailing Address - Street 2:
Mailing Address - City:CHURCH HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37642-1109
Mailing Address - Country:US
Mailing Address - Phone:423-863-0827
Mailing Address - Fax:
Practice Address - Street 1:2005 VENTURE PARK
Practice Address - Street 2:STE 23
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-1098
Practice Address - Country:US
Practice Address - Phone:423-863-0827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier