Provider Demographics
NPI:1285911198
Name:MED MOBILE LLC
Entity type:Organization
Organization Name:MED MOBILE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOOKMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-304-9272
Mailing Address - Street 1:2800 PARKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45440-1539
Mailing Address - Country:US
Mailing Address - Phone:937-304-9272
Mailing Address - Fax:937-985-9126
Practice Address - Street 1:2800 PARKLAWN DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45440-1539
Practice Address - Country:US
Practice Address - Phone:937-304-9272
Practice Address - Fax:937-985-9126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-05
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRV999798343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)