=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245975135
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOBILE URGENT CARE MEDICAL SERVICES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2022
-----------------------------------------------------
Last Update Date | 02/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 COOPER RD STE 1
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-3800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-349-4230
-----------------------------------------------------
Fax | 877-282-9624
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 685 3RD AVE FL 9
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10017-4151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-443-6246
-----------------------------------------------------
Fax | 833-907-2235
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NATIONAL DIRECTOR OF REVENUE CYCLE
-----------------------------------------------------
Name | ROBERT MBONYE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 585-278-0502
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------