Provider Demographics
NPI:1427697556
Name:REDICARE MOBILE HEALTH SERVICE
Entity type:Organization
Organization Name:REDICARE MOBILE HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICIAN ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:BROTHERS
Authorized Official - Last Name:TOLLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:240-743-8520
Mailing Address - Street 1:12410 MILESTONE CENTER DR STE 600
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-7102
Mailing Address - Country:US
Mailing Address - Phone:301-307-5335
Mailing Address - Fax:667-256-7022
Practice Address - Street 1:12410 MILESTONE CENTER DR STE 600
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-7102
Practice Address - Country:US
Practice Address - Phone:240-743-8520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCPA031239OtherDISTRICT OF COLUMBIA PHYSICIAN ASSISTANT LICENSE
VA0110007406OtherVA PHYSICIAN ASSISTANT LICENSE
MDPA86989OtherMD CDS
NC0010-10529OtherNC PHYSICIAN ASSISTANT LICENSE
MDC05839OtherMARYLAND PHYSICIAN ASSISTANT LICENSE
MDME3667372OtherMD DEA