Provider Demographics
NPI:1891966073
Name:MUTUAL MEDICAL, LLC
Entity Type:Organization
Organization Name:MUTUAL MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:A
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-677-1299
Mailing Address - Street 1:PO BOX 1426
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-1426
Mailing Address - Country:US
Mailing Address - Phone:336-677-1299
Mailing Address - Fax:336-677-1219
Practice Address - Street 1:108 SHARON DR
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-6769
Practice Address - Country:US
Practice Address - Phone:336-677-1299
Practice Address - Fax:336-677-1219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704965Medicaid
NC6122960001Medicare NSC