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General NPI Number Information
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NPI Number | 1245983022
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Entity Type | Organization
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Legal Business Name | MOBILE MEDICAL OPERATING COMPANY LLC
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Dates
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Enumeration Date | 02/01/2022
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 1840 SE PORT ST LUCIE BLVD STE 1840
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-5545
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Country | US
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Telephone | 772-221-7620
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Fax | 772-221-9903
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Provider Business Mailing Address
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Address Line | 4655 SALISBURY RD STE 110
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City | JACKSONVILLE
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State | FL
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Zip | 32256-0957
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Country | US
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Telephone | 904-733-1003
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Fax | 904-448-8855
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Authorized Official
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Title or Position | SECRETARY & CAO
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Name | MR. ROBERT YOUNG
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Credential |
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Telephone | 904-733-1003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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