Provider Demographics
NPI:1366613150
Name:COBBLER STATION FAMILY CLINIC
Entity type:Organization
Organization Name:COBBLER STATION FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOST
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-949-0140
Mailing Address - Street 1:5130 CHARLESTOWN RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9483
Mailing Address - Country:US
Mailing Address - Phone:812-949-0140
Mailing Address - Fax:812-949-0279
Practice Address - Street 1:5130 CHARLESTOWN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9483
Practice Address - Country:US
Practice Address - Phone:812-949-0140
Practice Address - Fax:812-949-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty