Provider Demographics
NPI: | 1487930848 |
---|---|
Name: | MOBILCARE MEDICAL, INC. |
Entity type: | Organization |
Organization Name: | MOBILCARE MEDICAL, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | REIMBURSEMENT DIRECTOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | DONNA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LESLIE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 901-526-0202 |
Mailing Address - Street 1: | 5821 RANGELINE RD |
Mailing Address - Street 2: | BLDG 105 |
Mailing Address - City: | THEODORE |
Mailing Address - State: | AL |
Mailing Address - Zip Code: | 36582-5209 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 251-443-9111 |
Mailing Address - Fax: | 251-443-9111 |
Practice Address - Street 1: | 6601 AIRPORT BLVD |
Practice Address - Street 2: | SUITE B |
Practice Address - City: | MOBILE |
Practice Address - State: | AL |
Practice Address - Zip Code: | 36608-3705 |
Practice Address - Country: | US |
Practice Address - Phone: | 251-443-9111 |
Practice Address - Fax: | 251-633-2920 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-10-31 |
Last Update Date: | 2011-10-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AL | 1009 | 332B00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies |