Provider Demographics
NPI:1659711059
Name:MEDICAL NUTRITION SERVICES LLC
Entity Type:Organization
Organization Name:MEDICAL NUTRITION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MN, FNP-C
Authorized Official - Phone:225-953-3100
Mailing Address - Street 1:24400 PERDIDO BEACH BLVD
Mailing Address - Street 2:SUITE #016
Mailing Address - City:ORANGE BEACH
Mailing Address - State:AL
Mailing Address - Zip Code:36561-6072
Mailing Address - Country:US
Mailing Address - Phone:251-622-5881
Mailing Address - Fax:
Practice Address - Street 1:24400 PERDIDO BEACH BLVD
Practice Address - Street 2:SUITE #016
Practice Address - City:ORANGE BEACH
Practice Address - State:AL
Practice Address - Zip Code:36561-6072
Practice Address - Country:US
Practice Address - Phone:251-622-5881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty