Organization
MMOC, LLC
Active
Other names
Active Infusion
Organization subpart
No
Provider details
NPI number
Authorized official
N J N (MEMBER)
(555) 555-1212
Entity
Organization
Contact information
Practice address
3665 BAY RD, SAGINAW, MI 48603-2429
(989) 799-4590
(989) 799-4432
Mailing address
25219 DEQUINDRE RD, MADISON HEIGHTS, MI 48071-4211
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336H0001X
Home Infusion Therapy Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3517617
—
MI
01
—
470G300030
BCBSM HIT
MI
01
—
540G303890
BCBSM PIN
MI
Enumeration date
07/28/2006
Last updated
05/25/2012
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