Provider Demographics
NPI: | 1093131559 |
---|---|
Name: | SAMEERAH ALI MOBILE MED PLLC |
Entity Type: | Organization |
Organization Name: | SAMEERAH ALI MOBILE MED PLLC |
Other - Org Name: | SAMEERAH ALI |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | OWNER/OPERATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SAMEERAH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ALI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | FNP |
Authorized Official - Phone: | 480-457-0422 |
Mailing Address - Street 1: | 2072 NASHBORO BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | NASHVILLE |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37217-3869 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 480-457-0422 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1602 8TH AVE S |
Practice Address - Street 2: | |
Practice Address - City: | NASHVILLE |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37203-5009 |
Practice Address - Country: | US |
Practice Address - Phone: | 615-379-8474 |
Practice Address - Fax: | 615-730-7132 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-03-07 |
Last Update Date: | 2014-08-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | 261QP2300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |