Provider Demographics
NPI:1528752383
Name:MOBILE HEALTHCARE PROVIDERS, LLC
Entity type:Organization
Organization Name:MOBILE HEALTHCARE PROVIDERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:LIZETTE
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:716-472-5207
Mailing Address - Street 1:3788 OXFORD CIR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-7700
Mailing Address - Country:US
Mailing Address - Phone:716-472-5201
Mailing Address - Fax:
Practice Address - Street 1:3788 OXFORD CIR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30340-7700
Practice Address - Country:US
Practice Address - Phone:716-472-5201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health