Provider Demographics
NPI:1104206457
Name:FORWARD MOBILE MEDICS, LLC
Entity Type:Organization
Organization Name:FORWARD MOBILE MEDICS, LLC
Other - Org Name:FORWARD MOBILE MEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:N
Authorized Official - Last Name:ELLAH
Authorized Official - Suffix:
Authorized Official - Credentials:RCMA
Authorized Official - Phone:253-881-1651
Mailing Address - Street 1:PO BOX 2022
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-2022
Mailing Address - Country:US
Mailing Address - Phone:253-881-1651
Mailing Address - Fax:253-600-3513
Practice Address - Street 1:340 N SAM HOUSTON PKWY E STE 165L
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3307
Practice Address - Country:US
Practice Address - Phone:253-881-1651
Practice Address - Fax:253-600-3513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246RP1900X, 251F00000X
TX261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
No251F00000XAgenciesHome InfusionGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty