Provider Demographics
NPI:1871031872
Name:MNR INDUSTRIES LLC
Entity Type:Organization
Organization Name:MNR INDUSTRIES LLC
Other - Org Name:EXPRESSCARE OF MIDDLE RIVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BILLING & CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-420-6970
Mailing Address - Street 1:1505 E CHURCHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4742
Mailing Address - Country:US
Mailing Address - Phone:410-420-6970
Mailing Address - Fax:410-420-6967
Practice Address - Street 1:1470 MARTIN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21220-4111
Practice Address - Country:US
Practice Address - Phone:410-686-4084
Practice Address - Fax:410-686-4087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD090NMedicare PIN