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NPI Code Detail

MEDICARE: MOBILE DOC ALLIANCE LLC

MEDICARE: MOBILE DOC ALLIANCE 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
1207QH0002XHospice and Palliative Medicine (Family Medicine) Physician
2363A00000XPhysician Assistant
3363L00000XNurse Practitioner
4363LP2300XPrimary Care Nurse Practitioner
5207QG0300XGeriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number : 1932648607
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOBILE DOC ALLIANCE LLC
Provider Business Mailing Address
First Line : 2355 E CAMELBACK RD
Second Line : STE 615
City : PHOENIX
State : AZ
Zip : 85016-3458
Country : US
Telephone Number : 480-359-3998
Fax Number : 480-385-6785
Provider Business Practice Location Address
First Line : 2355 E CAMELBACK RD
Second Line : STE 615
City : PHOENIX
State : AZ
Zip : 85016-3458
Country : US
Telephone Number : 480-359-3998
Fax Number : 480-385-6785
Authorized Official
Title or Position : MANAGING MEMBER
Name : MAI SHANNON
Credential :
Telephone Number : 480-359-3998
Provider Enumeration Date : 02/15/2017
Last Update Date : 02/15/2017

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