Healthcare Provider Details

I. General information

NPI: 1548249212
Provider Name (Legal Business Name): MOBILE NURSING SERVICES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 AVENUE G
FORT MADISON IA
52627-2915
US

IV. Provider business mailing address

705 AVENUE G
FORT MADISON IA
52627-2915
US

V. Phone/Fax

Practice location:
  • Phone: 319-372-8023
  • Fax: 319-372-8770
Mailing address:
  • Phone: 319-372-8023
  • Fax: 319-372-8770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier67157
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBCBS NUMBER
# 2
Identifier0671578
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: MRS. SUSAN MARIE BECKER
Title or Position: ADMINISTRATOR
Credential: RN, B.S.N.
Phone: 319-372-8023