Provider Demographics
NPI:1912327461
Name:M & M ULTRASPORTS, INC.
Entity Type:Organization
Organization Name:M & M ULTRASPORTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:MEGILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-412-8020
Mailing Address - Street 1:1479 BELCHER RD S
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-5200
Mailing Address - Country:US
Mailing Address - Phone:727-412-8020
Mailing Address - Fax:727-754-9815
Practice Address - Street 1:1479 BELCHER RD S STE H
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-5203
Practice Address - Country:US
Practice Address - Phone:727-412-8020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies