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General NPI Number Information
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NPI Number | 1013343367
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Entity Type | Organization
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Legal Business Name | MOBILE ASC, LLC
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Dates
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Enumeration Date | 09/18/2013
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Last Update Date | 09/18/2013
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Provider Practice Location Address
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Address Line | 1007 TIVOLI DR
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City | NAPLES
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State | FL
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Zip | 34104-0863
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Country | US
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Telephone | 773-756-5760
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Fax | 773-714-1229
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Provider Business Mailing Address
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Address Line | 8420 W BRYN MAWR AVE SUITE 300
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City | CHICAGO
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State | IL
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Zip | 60631-3479
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Country | US
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Telephone | 773-756-5760
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Fax | 773-714-1229
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Authorized Official
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Title or Position | CFO
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Name | JOSHUA GANTZ
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Credential |
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Telephone | 773-756-5760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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