MEDICARE: MOBILMED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1639555162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILMED

Provider Business Mailing Address
First Line	:	4160 NE SANDY BLVD
Second Line	:	SUITE 1200
City	:	PORTLAND
State	:	OR
Zip	:	97212-5336
Country	:	US
Telephone Number	:	503-249-9000
Fax Number	:	503-719-6829

Provider Business Practice Location Address
First Line	:	4160 NE SANDY BLVD
Second Line	:	SUITE 1200
City	:	PORTLAND
State	:	OR
Zip	:	97212-5336
Country	:	US
Telephone Number	:	503-249-9000
Fax Number	:	503-719-6829

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK E. HOSKO
Credential	:	M.D.
Telephone Number	:	503-249-9000

Provider Enumeration Date	:	08/06/2015
Last Update Date	:	08/06/2015

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Directions to “MOBILMED ” Practice Location

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