Healthcare Provider Details

I. General information

NPI: 1396169587
Provider Name (Legal Business Name): MOBILE MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 CAYER LN SUITE C
COLUMBIA TN
38401-7383
US

IV. Provider business mailing address

PO BOX 210929
NASHVILLE TN
37221-0929
US

V. Phone/Fax

Practice location:
  • Phone: 615-624-1613
  • Fax:
Mailing address:
  • Phone: 615-624-1613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MEKONNEN S KIDANE
Title or Position: OWNER/PROVIDER
Credential: DNP
Phone: 615-624-1613