Healthcare Provider Details

I. General information

NPI: 1003002759
Provider Name (Legal Business Name): MOBILE PHYSICIAN SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6804 CECELIA DR
NEW PORT RICHEY FL
34653-4935
US

IV. Provider business mailing address

6804 CECELIA DR
NEW PORT RICHEY FL
34653-4935
US

V. Phone/Fax

Practice location:
  • Phone: 727-232-0644
  • Fax: 888-546-0488
Mailing address:
  • Phone: 855-232-0644
  • Fax: 888-546-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0086161
License Number StateFL

VIII. Authorized Official

Name: DR. PETER RADICE
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 855-232-0644