1427288042 NPI number — MOBILE HEALTH CENTER PC

Table of content: (NPI 1427288042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427288042 NPI number — MOBILE HEALTH CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILE HEALTH CENTER 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:
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:
1427288042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4102 WOOLWORTH AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68105-1851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-444-3221
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4737 SOUTH 96TH ST
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-339-3187
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WILKINS
Authorized Official First Name:
SHANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
402-444-3221

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10025450000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025882700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025902200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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