=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255682274
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICAL MOBILE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2012
-----------------------------------------------------
Last Update Date | 06/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7211 REGENCY SQUARE BLVD STE 106
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-3137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-343-6014
-----------------------------------------------------
Fax | 832-391-6997
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7211 REGENCY SQUARE BLVD STE 106
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-3137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-205-1834
-----------------------------------------------------
Fax | 832-391-6997
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANNTTUNETTE NICOLE BUSH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-343-6014
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305S00000X
-----------------------------------------------------
Taxonomy Name | Point of Service
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------