Provider Demographics
NPI:1639869092
Name:MOMMIEANDME3D4D
Entity Type:Organization
Organization Name:MOMMIEANDME3D4D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIAGNOSTIC MEDICAL SONOGRAPHER
Authorized Official - Prefix:
Authorized Official - First Name:SHADELL
Authorized Official - Middle Name:N
Authorized Official - Last Name:CATER
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RVT
Authorized Official - Phone:213-359-8993
Mailing Address - Street 1:2733 FLORA LEE DR S
Mailing Address - Street 2:
Mailing Address - City:NESBIT
Mailing Address - State:MS
Mailing Address - Zip Code:38651-7008
Mailing Address - Country:US
Mailing Address - Phone:213-359-8993
Mailing Address - Fax:
Practice Address - Street 1:2733 FLORA LEE DR S
Practice Address - Street 2:
Practice Address - City:NESBIT
Practice Address - State:MS
Practice Address - Zip Code:38651-7008
Practice Address - Country:US
Practice Address - Phone:213-359-8993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty