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NPI Code Detail

MEDICARE: BOBBY MONGOLD

MEDICARE: BOBBY MONGOLD
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
1374U00000XHome Health Aide

General Provider Information

NPI Number : 1871440099
Entity Type Code : Individual
Provider Name (Legal Business Name) : BOBBY MONGOLD
Provider Business Mailing Address
First Line : 1792 DEEP SPRING RD
Second Line :
City : PETERSBURG
State : WV
Zip : 26847-8657
Country : US
Telephone Number : 304-257-2381
Fax Number :
Provider Business Practice Location Address
First Line : 1792 DEEP SPRING RD
Second Line :
City : PETERSBURG
State : WV
Zip : 26847-8657
Country : US
Telephone Number : 304-257-2381
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2026
Last Update Date : 03/16/2026

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Directions to “ BOBBY MONGOLD ” Practice Location

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