Provider Demographics
NPI:1184962342
Name:MED MANAGEMENT PLUS
Entity type:Organization
Organization Name:MED MANAGEMENT PLUS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-296-2552
Mailing Address - Street 1:PO BOX 17708
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-7708
Mailing Address - Country:US
Mailing Address - Phone:601-296-2552
Mailing Address - Fax:601-296-2397
Practice Address - Street 1:1110 COWAN RD
Practice Address - Street 2:SUITE B
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3441
Practice Address - Country:US
Practice Address - Phone:601-296-2552
Practice Address - Fax:601-296-2397
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MED MANAGEMENT PLUS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care