Basic Information
| Provider Information | |||||||||
| NPI: | 1861056921 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOBILE PHYSICIAN SERVICES INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6804 CECELIA DR | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346534935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552320644 | ||||||||
| FaxNumber: | 8885460488 | ||||||||
| Practice Location | |||||||||
| Address1: | 4031 COLONEL GLENN HWY STE 133 | ||||||||
| Address2: | |||||||||
| City: | BEAVERCREEK TOWNSHIP | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454312774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552320644 | ||||||||
| FaxNumber: | 8885460488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2019 | ||||||||
| LastUpdateDate: | 04/24/2019 | ||||||||
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| AuthorizedOfficialLastName: | WACKSMAN | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7272320644 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QP2300X | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 261QP3300X | N | Ambulatory Health Care Facilities | Clinic/Center | Pain | 207RH0002X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
No ID Information.