Provider Demographics
NPI:1023131612
Name:MME I INC.
Entity type:Organization
Organization Name:MME I INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:N
Authorized Official - Last Name:WAGGONER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-872-0031
Mailing Address - Street 1:3552 SHERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-3533
Mailing Address - Country:US
Mailing Address - Phone:325-223-0231
Mailing Address - Fax:325-223-1237
Practice Address - Street 1:500 N BEDELL AVE
Practice Address - Street 2:SUITE F
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-4859
Practice Address - Country:US
Practice Address - Phone:830-775-1700
Practice Address - Fax:830-775-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1183660001Medicare NSC