Provider Demographics
NPI:1215385372
Name:MY MOBILE PRIMARY HEALTH CARE LLC
Entity Type:Organization
Organization Name:MY MOBILE PRIMARY HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SATIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-508-9034
Mailing Address - Street 1:9215 TRADERS XING APT F
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1630
Mailing Address - Country:US
Mailing Address - Phone:240-565-8316
Mailing Address - Fax:
Practice Address - Street 1:4201 NORTHVIEW DR STE 410
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-2668
Practice Address - Country:US
Practice Address - Phone:202-681-9661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR187947261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health