Organization
MOMENTUM MEDICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ORTON F GRINNELL II CSFA/CST (PRESIDENT)
(228) 263-0037
Entity
Organization
Contact information
Practice address
400 WAINWRIGHT ST, WAVELAND, MS 39576-2511
(228) 263-0037
(228) 466-4925
Mailing address
400 WAINWRIGHT ST, WAVELAND, MS 39576-2511
(228) 263-0037
(228) 466-4925
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115739
CSFA CERTIFICATE NUMBER
—
Enumeration date
07/25/2013
Last updated
07/25/2013
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