Provider Demographics
NPI:1235450339
Name:MOBILE PRACTICE GROUP LLC
Entity Type:Organization
Organization Name:MOBILE PRACTICE GROUP LLC
Other - Org Name:JENNIFER BAILEY JONES MBR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-299-0003
Mailing Address - Street 1:200 BRYAN PL
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104
Mailing Address - Country:US
Mailing Address - Phone:972-299-0003
Mailing Address - Fax:972-299-0004
Practice Address - Street 1:200 BRYAN PL
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104
Practice Address - Country:US
Practice Address - Phone:972-299-0003
Practice Address - Fax:972-299-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-13
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
TXPA04612367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB107567Medicare PIN