Healthcare Provider Details

I. General information

NPI: 1760447866
Provider Name (Legal Business Name): MOBILE-SC, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6144 AIRPORT BLVD STE A
MOBILE AL
36608-3143
US

IV. Provider business mailing address

6144 AIRPORT BLVD STE A
MOBILE AL
36608-3143
US

V. Phone/Fax

Practice location:
  • Phone: 251-438-3614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEA HARBOR
Title or Position: VP
Credential:
Phone: 205-545-2572