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General NPI Number Information
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NPI Number | 1568863785
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Entity Type | Organization
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Legal Business Name | MOBILE PICC SPECIALISTS
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Dates
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Enumeration Date | 09/07/2014
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Last Update Date | 09/07/2014
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Provider Practice Location Address
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Address Line | 39 ASHWOOD RD
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City | BUTLER
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State | AL
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Zip | 36904-2860
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Country | US
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Telephone | 888-550-6130
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Fax | 888-550-8390
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Provider Business Mailing Address
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Address Line | 39 ASHWOOD RD
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City | BUTLER
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State | AL
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Zip | 36904-2860
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Country | US
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Telephone | 888-550-6130
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Fax | 888-550-8390
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Authorized Official
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Title or Position | PHLEBOTOMY
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Name | MS. JACQUELINE WEBB
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Credential | RN
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Telephone | 888-550-6130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 1-106108
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License Number State | AL
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