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General NPI Number Information
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NPI Number | 1003002759
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Entity Type | Organization
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Legal Business Name | MOBILE PHYSICIAN SERVICES INC.
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Dates
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Enumeration Date | 09/17/2007
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | 6804 CECELIA DR
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City | NEW PORT RICHEY
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State | FL
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Zip | 34653-4935
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Country | US
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Telephone | 727-232-0644
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Fax | 888-546-0488
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Provider Business Mailing Address
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Address Line | 6804 CECELIA DR
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City | NEW PORT RICHEY
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State | FL
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Zip | 34653-4935
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Country | US
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Telephone | 855-232-0644
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Fax | 888-546-0488
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RICHARD M WACKSMAN
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Credential | M.D.
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Telephone | 855-232-0644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0086161
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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