Healthcare Provider Details

I. General information

NPI: 1558682179
Provider Name (Legal Business Name): MOBILE MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 COMMERCE DR STE A
PERRYSBURG OH
43551-5276
US

IV. Provider business mailing address

12910 SHELBYVILLE RD STE 300
LOUISVILLE KY
40243-2404
US

V. Phone/Fax

Practice location:
  • Phone: 502-813-4415
  • Fax: 502-996-8282
Mailing address:
  • Phone: 502-244-2420
  • Fax: 502-996-8282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW D FELTZ
Title or Position: CLINICAL DIRECTOR
Credential: OD
Phone: 502-813-4415