Healthcare Provider Details

I. General information

NPI: 1558382671
Provider Name (Legal Business Name): MOBILE SURGICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD SUITE D231
MOBILE AL
36608-6705
US

IV. Provider business mailing address

6701 AIRPORT BLVD SUITE D231
MOBILE AL
36608-6705
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-4064
  • Fax: 251-633-0122
Mailing address:
  • Phone: 251-633-4064
  • Fax: 251-633-0122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number00026047
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number00006907
License Number StateAL

VIII. Authorized Official

Name: WILLIAM MALCOLM LIGHTFOOT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 251-633-4064