MEDICARE: MOBILE DIALYSIS SOLUTIONS LLC

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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1912860941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE DIALYSIS SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	14910 N DALE MABRY HWY UNIT 340526
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-1814
Country	:	US
Telephone Number	:	813-786-0133
Fax Number	:

Provider Business Practice Location Address
First Line	:	12804 EAGLES ENTRY DR
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-2837
Country	:	US
Telephone Number	:	813-786-0133
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OLAOLU ODEWOLE
Credential	:
Telephone Number	:	813-786-0133

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	03/11/2026

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