Provider Demographics
NPI:1396169587
Name:MOBILE MEDICAL CARE
Entity type:Organization
Organization Name:MOBILE MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MEKONNEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIDANE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:615-624-1613
Mailing Address - Street 1:PO BOX 210929
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-0929
Mailing Address - Country:US
Mailing Address - Phone:615-624-1613
Mailing Address - Fax:
Practice Address - Street 1:2504 CAYER LN
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-7383
Practice Address - Country:US
Practice Address - Phone:615-624-1613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty