1326812777 NPI number — MOBICLINIX LLC

Table of content: (NPI 1326812777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326812777 NPI number — MOBICLINIX LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBICLINIX 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:
1326812777
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1999 OLD HIGHWAY 141
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONSON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51007-8069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-454-0648
Provider Business Mailing Address Fax Number:
712-248-8720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 SERGEANT SQUARE DR STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SERGEANT BLUFF
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51054-8599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-315-3845
Provider Business Practice Location Address Fax Number:
712-248-8720
Provider Enumeration Date:
11/07/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AMICK
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
DAWN
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
888-315-3845

Provider Taxonomy Codes

  • Taxonomy code: 163WW0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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