Provider Demographics
NPI:1588764658
Name:MOBILE ADULT CARE LLC
Entity type:Organization
Organization Name:MOBILE ADULT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:STUDDARD
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:251-342-2641
Mailing Address - Street 1:100 MEMORIAL HOSPITAL DR
Mailing Address - Street 2:STE 3A
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1183
Mailing Address - Country:US
Mailing Address - Phone:251-342-2641
Mailing Address - Fax:251-343-9507
Practice Address - Street 1:100 MEMORIAL HOSPITAL DR
Practice Address - Street 2:SUITE 3A
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608
Practice Address - Country:US
Practice Address - Phone:251-342-2641
Practice Address - Fax:251-343-9507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG910Medicare PIN