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General NPI Number Information
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NPI Number | 1366727463
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Entity Type | Organization
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Legal Business Name | MOBILE MEDICAL, LLC
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Dates
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Enumeration Date | 10/20/2011
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Last Update Date | 09/13/2025
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Provider Practice Location Address
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Address Line | 345 N RIVERVIEW ST STE 500
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City | WICHITA
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State | KS
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Zip | 67203-4265
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Country | US
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Telephone | 316-616-1055
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Fax | 855-633-0585
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Provider Business Mailing Address
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Address Line | 345 N RIVERVIEW ST STE 412
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City | WICHITA
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State | KS
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Zip | 67203-4202
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Country | US
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Telephone | 551-295-8223
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BRENT SANDERS
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Credential |
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Telephone | 316-616-1055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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