Healthcare Provider Details

I. General information

NPI: 1326812777
Provider Name (Legal Business Name): MOBICLINIX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 OLD HIGHWAY 141
BRONSON IA
51007-8069
US

IV. Provider business mailing address

PO BOX 104
SERGEANT BLUFF IA
51054-0104
US

V. Phone/Fax

Practice location:
  • Phone: 888-315-3845
  • Fax: 712-248-8720
Mailing address:
  • Phone: 712-454-0648
  • Fax: 712-248-8720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE DAWN AMICK
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 712-454-0648