Healthcare Provider Details

I. General information

NPI: 1730888199
Provider Name (Legal Business Name): MOBILE MEDICAL HEALTHCARE, PROFESSIONAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 02/24/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 COMMERCE ST STE 101
LAKE MARY FL
32746-6217
US

IV. Provider business mailing address

35 W 35TH ST FL 5
NEW YORK NY
10001-2271
US

V. Phone/Fax

Practice location:
  • Phone: 844-553-6246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN BUCKLEY
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 844-553-6246