Provider Demographics
NPI:1700017514
Name:M & M REHAB INC
Entity Type:Organization
Organization Name:M & M REHAB INC
Other - Org Name:MID-FLORIDA PROSTHETICS & ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSTAMANTE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:352-331-3399
Mailing Address - Street 1:2300 SE 17TH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-9107
Mailing Address - Country:US
Mailing Address - Phone:352-351-3207
Mailing Address - Fax:352-351-3267
Practice Address - Street 1:2300 SE 17TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-9107
Practice Address - Country:US
Practice Address - Phone:352-351-3207
Practice Address - Fax:352-351-3267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR89335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM0794OtherBLUE CROSS BLUE SHIELD
FL021846400Medicaid
FL1267440005Medicare NSC