Provider Demographics
NPI:1043485196
Name:NORTHERN MOBILE MEDICAL DIAGNOSTICS
Entity Type:Organization
Organization Name:NORTHERN MOBILE MEDICAL DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:B
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-675-8760
Mailing Address - Street 1:1084 INDUSTRIAL PARKWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571
Mailing Address - Country:US
Mailing Address - Phone:251-675-8760
Mailing Address - Fax:251-675-8100
Practice Address - Street 1:1084 INDUSTRIAL PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-3726
Practice Address - Country:US
Practice Address - Phone:251-675-8760
Practice Address - Fax:251-675-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10060208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH438OtherMEDICARE GROUP NUMBER