Provider Demographics
NPI:1942284583
Name:M&M ORTHOTIC & PROSTHETIC CENTERS, LLC
Entity type:Organization
Organization Name:M&M ORTHOTIC & PROSTHETIC CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MADSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-992-1200
Mailing Address - Street 1:3061 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2298
Mailing Address - Country:US
Mailing Address - Phone:702-992-1200
Mailing Address - Fax:702-992-1205
Practice Address - Street 1:3061 S MARYLAND PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2298
Practice Address - Country:US
Practice Address - Phone:702-992-1200
Practice Address - Fax:702-992-1205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4831640001Medicare ID - Type UnspecifiedMEDICARE POVIDER NUMBER