Healthcare Provider Details

I. General information

NPI: 1568097459
Provider Name (Legal Business Name): MOBILE MEDICAL TECHNICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2329 W GRAND BLVD
DETROIT MI
48208-1205
US

IV. Provider business mailing address

2329 W GRAND BLVD
DETROIT MI
48208-1205
US

V. Phone/Fax

Practice location:
  • Phone: 313-657-4610
  • Fax:
Mailing address:
  • Phone: 313-657-4610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: MARKEA JENKINS
Title or Position: ADMINSTRATOR
Credential:
Phone: 313-657-4610