Provider Demographics
NPI:1265874648
Name:MOMENTUM MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:MOMENTUM MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ORTON
Authorized Official - Middle Name:F
Authorized Official - Last Name:GRINNELL
Authorized Official - Suffix:II
Authorized Official - Credentials:CSFA/CST
Authorized Official - Phone:228-263-0037
Mailing Address - Street 1:400 WAINWRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:WAVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39576-2511
Mailing Address - Country:US
Mailing Address - Phone:228-263-0037
Mailing Address - Fax:228-466-4925
Practice Address - Street 1:400 WAINWRIGHT ST
Practice Address - Street 2:
Practice Address - City:WAVELAND
Practice Address - State:MS
Practice Address - Zip Code:39576-2511
Practice Address - Country:US
Practice Address - Phone:228-263-0037
Practice Address - Fax:228-466-4925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
115739OtherCSFA CERTIFICATE NUMBER