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General NPI Number Information
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NPI Number | 1588733034
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Entity Type | Organization
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Legal Business Name | IMC MOBILE MEDICAL GROUP
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 6001 AIRPORT BLVD
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City | MOBILE
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State | AL
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Zip | 36608-3142
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Country | US
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Telephone | 251-342-6944
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Fax | 251-344-6464
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Provider Business Mailing Address
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Address Line | 6001 AIRPORT BLVD
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City | MOBILE
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State | AL
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Zip | 36608-3142
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Country | US
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Telephone | 251-342-6944
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Fax | 251-344-6464
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. MARIANNE F SMITH
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Credential |
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Telephone | 251-342-6944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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