Provider Demographics
NPI:1053444968
Name:MICHAEL R MULLINS II INC
Entity type:Organization
Organization Name:MICHAEL R MULLINS II INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:304-752-1450
Mailing Address - Street 1:301 GEORGE KOSTAS DR
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3493
Mailing Address - Country:US
Mailing Address - Phone:304-752-1450
Mailing Address - Fax:304-752-4390
Practice Address - Street 1:301 GEORGE KOSTAS DR
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3493
Practice Address - Country:US
Practice Address - Phone:304-752-1450
Practice Address - Fax:304-752-4390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0147367000Medicaid
0569890001Medicare ID - Type Unspecified