Healthcare Provider Details

I. General information

NPI: 1861180952
Provider Name (Legal Business Name): MOBILE MEDICAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8551 N 125TH EAST AVE
OWASSO OK
74055-2110
US

IV. Provider business mailing address

1607 SARATOGA WAY
EDMOND OK
73003-3552
US

V. Phone/Fax

Practice location:
  • Phone: 918-638-7737
  • Fax:
Mailing address:
  • Phone: 918-638-7737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN CLOUD
Title or Position: MANAGER
Credential: DO
Phone: 918-638-7737