1588633325 NPI number — MOBILE CARE, INC

Table of content: (NPI 1588633325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588633325 NPI number — MOBILE CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILE CARE, INC
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:
1588633325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 80735
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70598-0735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-346-0801
Provider Business Mailing Address Fax Number:
281-346-0802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 HUGH WALLIS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70508-2107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-289-5456
Provider Business Practice Location Address Fax Number:
337-289-0119
Provider Enumeration Date:
03/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEROUEN
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
281-346-0801

Provider Taxonomy Codes

  • Taxonomy code: 261QR0208X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0118190 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1677582 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00060242 . This is a "STATE EMPLOYEES GROUP" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: F0306 . This is a "BLUE CROSS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 0247848 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 630000814 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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