1952200438 NPI number — MAMMOTH MEDICAL MANAGEMENT LLC

Table of content: (NPI 1952200438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952200438 NPI number — MAMMOTH MEDICAL MANAGEMENT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAMMOTH MEDICAL MANAGEMENT LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952200438
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2425 S STEARMAN DR STE 205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85286-5042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-944-1781
Provider Business Mailing Address Fax Number:
480-907-1241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2425 S STEARMAN DR STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85286-5042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-944-1781
Provider Business Practice Location Address Fax Number:
480-907-1241
Provider Enumeration Date:
11/02/2026

Additional Information

Authorized Official

Authorized Official Last Name:
WALLACE
Authorized Official First Name:
KATHRYN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXPERIENCE OFFICE
Authorized Official Telephone Number:
714-944-1781

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com