1952777062 NPI number — MOBILITY HEALTHCARE GROUP LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952777062 NPI number — MOBILITY HEALTHCARE GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILITY HEALTHCARE GROUP 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:
MOBILITY WELLNESS
Provider Other Organization Name Type Code:
3
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:
1952777062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5900 S LAKE FOREST DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
MCKINNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75070-2193
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-342-8708
Provider Business Mailing Address Fax Number:
214-451-6063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
431 STACY RD
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
FAIRVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75069-8741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-310-2547
Provider Business Practice Location Address Fax Number:
214-451-6063
Provider Enumeration Date:
08/12/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KURESHY
Authorized Official First Name:
ASHER
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
469-342-8708

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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