Provider Demographics
NPI:1427516335
Name:MOBILE MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:MOBILE MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:772-463-2453
Mailing Address - Street 1:10543 SW WHOOPING CRANE WAY
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-7806
Mailing Address - Country:US
Mailing Address - Phone:772-463-2453
Mailing Address - Fax:
Practice Address - Street 1:10543 SW WHOOPING CRANE WAY
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-7806
Practice Address - Country:US
Practice Address - Phone:724-632-4537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-10
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care