| Mmps, LLC | |
|
6435 Se Us Highway 301 Hawthorne FL 32640-7309 | |
| (352) 358-8070 | |
| (949) 577-4783 |
| Full Name | Mmps, LLC |
|---|---|
| Speciality | General Practice |
| Location | 6435 Se Us Highway 301, Hawthorne, Florida |
| Authorized Official Name and Position | Michell Mulberry (PROVIDER, OWNER) |
| Authorized Official Contact | 3523588070 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mmps, LLC 6435 Se Us Highway 301 Hawthorne FL 32640-7309 Ph: (352) 358-8070 | Mmps, LLC 6435 Se Us Highway 301 Hawthorne FL 32640-7309 Ph: (352) 358-8070 |
| NPI Number | 1831683861 |
|---|---|
| Provider Enumeration Date | 06/22/2018 |
| Last Update Date | 02/08/2021 |
| Certification Date | 02/08/2021 |
| Medicare PECOS PAC ID | 4981025095 |
|---|---|
| Medicare Enrollment ID | O20200528000109 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831683861 | NPI | - | NPPES |
| 107001000 | Medicaid | FL | |
| 106245700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (NU) | Primary |
| 363LA2200X | Nurse Practitioner - Adult Health | (NU) | Secondary |
| 363LP2300X | Nurse Practitioner - Primary Care | (NU) | Secondary |
| Provider Name | Michell Mulberry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902141260 PECOS PAC ID: 1456581362 Enrollment ID: I20171017001864 |
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