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General NPI Number Information
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NPI Number | 1114339827
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Entity Type | Organization
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Legal Business Name | MOBILE MEDIC LLC
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Dates
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Enumeration Date | 05/29/2014
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Last Update Date | 05/29/2014
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Provider Practice Location Address
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Address Line | 1305 WINNIPEG DR
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City | YUKON
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State | OK
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Zip | 73099
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Country | US
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Telephone | 405-261-6858
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Fax |
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Provider Business Mailing Address
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Address Line | 9412 SW 32 ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73179
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Country | US
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Telephone | 405-261-6858
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | ALLEN BENTLEY
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Credential |
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Telephone | 405-627-5578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | SAV 010
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License Number State | OK
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