Provider Demographics
NPI:1043648595
Name:MOBILE CARE PHYSICIANS LLC
Entity Type:Organization
Organization Name:MOBILE CARE PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:YARUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-559-4986
Mailing Address - Street 1:2601 N 3RD ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1104
Mailing Address - Country:US
Mailing Address - Phone:602-559-4986
Mailing Address - Fax:480-237-9676
Practice Address - Street 1:2601 N 3RD ST
Practice Address - Street 2:SUITE 305
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1104
Practice Address - Country:US
Practice Address - Phone:602-559-4986
Practice Address - Fax:480-237-9676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-19
Last Update Date:2013-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31732310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
01WCPBFAMedicare UPIN
OR0116PMedicare PIN