1255899837 NPI number — MOBILELIFE LLC

Table of content: (NPI 1255899837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255899837 NPI number — MOBILELIFE LLC

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
MOBILELIFE LLC
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:
1255899837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
73 AIRPORT RD STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARDEN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28704-9527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-676-2760
Provider Business Mailing Address Fax Number:
828-676-2759

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
73 AIRPORT RD STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARDEN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28704-9527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-676-2760
Provider Business Practice Location Address Fax Number:
828-676-2759
Provider Enumeration Date:
03/04/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FOX
Authorized Official First Name:
SHANE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER-MANAGER
Authorized Official Telephone Number:
828-676-2760

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02568 . This is a "NC BOARD OF PHARMACY DME & DEVICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".