Provider Demographics
NPI:1316577943
Name:MOBILE INFIRMARY ASSOCIATION
Entity Type:Organization
Organization Name:MOBILE INFIRMARY ASSOCIATION
Other - Org Name:MIMC RX4U AT SARALAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:NIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-435-8044
Mailing Address - Street 1:PO BOX 1468
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-1468
Mailing Address - Country:US
Mailing Address - Phone:251-435-8042
Mailing Address - Fax:251-435-8043
Practice Address - Street 1:95 SHELL ST STE 110
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-2202
Practice Address - Country:US
Practice Address - Phone:251-435-8042
Practice Address - Fax:251-435-8043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL246167Medicaid