Provider Demographics
NPI:1295045086
Name:MOBILE MEDICAL SERVICES L.L.C.
Entity Type:Organization
Organization Name:MOBILE MEDICAL SERVICES L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:863-257-1542
Mailing Address - Street 1:4304 NORTHCOURSE LN
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-8554
Mailing Address - Country:US
Mailing Address - Phone:863-257-1542
Mailing Address - Fax:888-386-8489
Practice Address - Street 1:4304 NORTHCOURSE LN
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-8554
Practice Address - Country:US
Practice Address - Phone:863-257-1542
Practice Address - Fax:888-386-8489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL660219300OtherMEDIPASS
FLP34905OtherUPIN
FL311292600Medicaid