MEDICARE: MOBSON CARE INCORPORATED

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	302F00000X	Exclusive Provider Organization	333391	MN

General Provider Information

NPI Number	:	1982828257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBSON CARE INCORPORATED

Provider Business Mailing Address
First Line	:	6269 CENTURY BLVD
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55429-1030
Country	:	US
Telephone Number	:	763-286-5224
Fax Number	:	763-560-3137

Provider Business Practice Location Address
First Line	:	6269 CENTURY BLVD
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55429-1030
Country	:	US
Telephone Number	:	763-286-5224
Fax Number	:	763-560-3137

Authorized Official
Title or Position	:	BRANCH COORDINATOR
Name	:	MR. MOBOLAJI SHIWONIKU
Credential	:
Telephone Number	:	763-286-5224

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	08/22/2020

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