Provider Demographics
NPI:1699853135
Name:M&M MEDICAL SUPPLY,INC.
Entity Type:Organization
Organization Name:M&M MEDICAL SUPPLY,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-539-3082
Mailing Address - Street 1:3113 W MARSHALL ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-4730
Mailing Address - Country:US
Mailing Address - Phone:804-539-3082
Mailing Address - Fax:
Practice Address - Street 1:3113 W MARSHALL ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-4730
Practice Address - Country:US
Practice Address - Phone:804-539-3082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA9102809332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9102809Medicaid