1245975135 NPI number — MOBILE URGENT CARE MEDICAL SERVICES PC

Table of content: (NPI 1245975135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245975135 NPI number — MOBILE URGENT CARE MEDICAL SERVICES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILE URGENT CARE MEDICAL SERVICES PC
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:
6
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:
1245975135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
685 3RD AVE FL 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10017-4151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-443-6246
Provider Business Mailing Address Fax Number:
833-907-2235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 COOPER RD STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-349-4230
Provider Business Practice Location Address Fax Number:
877-282-9624
Provider Enumeration Date:
05/04/2022

Additional Information

Authorized Official

Authorized Official Last Name:
MBONYE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
NATIONAL DIRECTOR OF REVENUE CYCLE
Authorized Official Telephone Number:
585-278-0502

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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