Healthcare Provider Details

I. General information

NPI: 1629668777
Provider Name (Legal Business Name): MOBILE HEART USA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 DAUPHIN ST STE 301
MOBILE AL
36606-4052
US

IV. Provider business mailing address

3290 DAUPHIN ST STE 301
MOBILE AL
36606-4052
US

V. Phone/Fax

Practice location:
  • Phone: 251-873-6280
  • Fax: 251-873-6281
Mailing address:
  • Phone: 251-873-6280
  • Fax: 251-873-6281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSAN H BRYAN
Title or Position: OFFICE ADMINISTRATOR
Credential: RN, BA, BSM
Phone: 251-435-8567