| Mimo Medical Services, Llc | |
|
2506 Crestview Dr Magnolia AR 71753-4336 | |
| (479) 530-1308 | |
| (479) 968-1673 |
| Full Name | Mimo Medical Services, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2506 Crestview Dr, Magnolia, Arkansas |
| Authorized Official Name and Position | Mimo Lemdja (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 4795301308 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mimo Medical Services, Llc Po Box 9178 Russellville AR 72811-9178 Ph: (800) 824-4094 | Mimo Medical Services, Llc 2506 Crestview Dr Magnolia AR 71753-4336 Ph: (479) 530-1308 |
| NPI Number | 1871107474 |
|---|---|
| Provider Enumeration Date | 09/02/2020 |
| Last Update Date | 09/02/2020 |
| Medicare PECOS PAC ID | 0244658524 |
|---|---|
| Medicare Enrollment ID | O20200918000687 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871107474 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Mimo R Lemdja |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023283710 PECOS PAC ID: 5698890317 Enrollment ID: I20100917000171 |
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