1558382671 NPI number — MOBILE SURGICAL SERVICES, P.C.

Table of content: (NPI 1558382671)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558382671 NPI number — MOBILE SURGICAL SERVICES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILE SURGICAL SERVICES, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558382671
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6701 AIRPORT BLVD
Provider Second Line Business Mailing Address:
SUITE D231
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36608-6705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-633-4064
Provider Business Mailing Address Fax Number:
251-633-0122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6701 AIRPORT BLVD
Provider Second Line Business Practice Location Address:
SUITE D231
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36608-6705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-633-4064
Provider Business Practice Location Address Fax Number:
251-633-0122
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIGHTFOOT
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
MALCOLM
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
251-633-4064

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  00006907 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: 00026047 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51523580 . This is a "BCBS-RFH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1710151 . This is a "UNITED HEALTHCARE-WML" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51006999 . This is a "BCBS-WML" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: HW0099964115 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: LI000006999 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00157802 . This is a "RAILROAD MEDICARE-RFH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 3700108 . This is a "UNITED HEALTHCARE-RFH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 020038001 . This is a "RAILROAD MEDICARE-WML" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: CI2733 . This is a "RAILROAD MEDICARE-GROUP" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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