Provider Demographics
NPI:1700350675
Name:MTM HEALTH SERVICES INC
Entity Type:Organization
Organization Name:MTM HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TYESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-643-2604
Mailing Address - Street 1:1610 17TH CT SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-6215
Mailing Address - Country:US
Mailing Address - Phone:772-643-2604
Mailing Address - Fax:
Practice Address - Street 1:1610 17TH CT SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-6215
Practice Address - Country:US
Practice Address - Phone:772-643-2604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities