MIMO MEDICAL SERVICES, LLC (NPI# 1871107474) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871107474 |
| Entity Type | Organization |
| Organization Name | MIMO MEDICAL SERVICES, LLC |
| Practice Address |
2506 Crestview Dr Magnolia AR 71753-4336 |
| Mailing Address |
Po Box 9178 Russellville AR 72811-9178 |
| Practice Telephone | 4795301308 |
| Practice Fax Number | 4799681673 |
| Mailing Telephone | 8008244094 |
| Mailing Fax Number | 4799681673 |
| Enumeration Date | 2020-09-02 |
| Last Update Date | 2020-09-02 |
| Authorized Official Name | MIMO LEMDJA (AUTHORIZED OFFICIAL) |
| Authorized Official Telephone | 4795301308 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
2506 CRESTVIEW DR |
| City | MAGNOLIA |
| State | AR |
| Zip Code | 71753-4336 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851939862 | Kylie Nokes | Occupational Therapy Assistant | 1403 High School Drive, Magnolia, AR 71753 | 2019-12-20 |
| 1225510266 | Douglas Palmer | Specialist/Technologist | 100 E University St, Magnolia, AR 71753 | 2018-09-06 |
| 1568940781 | Alyssa Scholl | Specialist/Technologist | Msc 8800, Magnolia, AR 71753 | 2018-07-31 |
| 1881141950 | Yuichi Takizawa | Specialist/Technologist | 2212 Lacari Dr., Fox Creek Apt #a1, Magnolia, AR 71753 | 2016-09-07 |
| 1609322981 | Stephen Baldwin Jr. | Specialist/Technologist | 100 E University Msc 9202, Magnolia, AR 71753 | 2016-08-28 |
| 1760830038 | Deborah Ellis | Developmental Therapist | 301 West Calhoun, Magnolia, ARKANSAS 71753 | 2016-05-27 |
| 1053720144 | Alaina Atkinson-murphy | Counselor | 1705 E North St, Magnolia, AR 71753 | 2014-08-04 |
| 1467701250 | Charles P Story | Physical Therapy Assistant | 191 E Columbia # 25, Magnolia, AR 71753 | 2012-09-07 |
| 1043565542 | Magnolia Surgery Center, LLC | Clinic/Center | 25 Columbia Road 47, Magnolia, AR 71753 | 2012-07-20 |
| 1427288232 | Emily Loftin | Physical Therapy Assistant | 310 West Calhoun Road, Magnolia, AR 71753 | 2009-07-15 |
| Find all providers in zip 71753 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528329562 | Australia D Clark | Family Medicine | 6318 Fm 1488 Rd Ste 100, Magnolia, TX 77354-2763 | 2012-06-06 |
| 1164688099 | Christian Edward Ong Dyhianto | Family Medicine | 6912 Fm 1488 Rd, Suite A, Magnolia, TX 77354-1527 | 2008-07-30 |
| 1124290390 | Vu Anh Phung | Family Medicine | 6022 Fm 1488 Rd, Magnolia, TX 77354-2542 | 2008-03-28 |
| 1285856971 | James William Chambliss | Family Medicine | 1701 E North St, Magnolia, AR 71753-3204 | 2007-05-03 |
| 1053477711 | Kimberly Renee Lemaster | Family Medicine | 111 Magnolia Street, Magnolia, MS 39652 | 2006-12-28 |
| 1023179207 | Randall Dean Walker | Family Medicine | 827 S. Magnolia Blvd, Suite 6, Magnolia, TX 77355 | 2006-12-12 |
| 1043385115 | Sunshine Primary Care Pa | Family Medicine | 33300 Egypt Ln, Suite A400, Magnolia, TX 77354-2739 | 2006-11-22 |
| 1841383957 | James Michael Stanton | Family Medicine | 827 Magnolia Blvd Ste 6, Magnolia, TX 77355-8553 | 2006-10-02 |
| 1689781007 | Lucius M. Lampton | Family Medicine | 111 Magnolia St, Magnolia, MS 39652-2825 | 2006-08-23 |
| 1558389098 | Francesco G Nicoletti | Family Medicine | 10025 Cleveland Ave S, Magnolia, OH 44643 | 2006-07-17 |
| Find all providers in MAGNOLIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.