Provider Demographics
NPI:1821456492
Name:MMDS FL IDTF
Entity Type:Organization
Organization Name:MMDS FL IDTF
Other - Org Name:MMDS MOBILE X-RAY IDTF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-480-4087
Mailing Address - Street 1:3011 HARRAH DR
Mailing Address - Street 2:SUITE L
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-6252
Mailing Address - Country:US
Mailing Address - Phone:423-480-4087
Mailing Address - Fax:
Practice Address - Street 1:4707 ENTERPRISE AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-7064
Practice Address - Country:US
Practice Address - Phone:423-480-4087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MMDS OF NORTH CAROLINA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory