Provider Demographics
NPI:1326012873
Name:MOBILE HEALTH CARE, INC
Entity Type:Organization
Organization Name:MOBILE HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:F
Authorized Official - Last Name:WIPPERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:219-872-7799
Mailing Address - Street 1:4511 N JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-7675
Mailing Address - Country:US
Mailing Address - Phone:219-872-7799
Mailing Address - Fax:219-872-8060
Practice Address - Street 1:4511 N JOHNSON RD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7675
Practice Address - Country:US
Practice Address - Phone:219-872-7799
Practice Address - Fax:219-872-8060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INXF200506335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000175431OtherANTHEM BLUE CROSS & BLUE
IN100165050BMedicaid
INP00168382OtherRAILROAD MEDICARE
IN630000140OtherUNITED HEALTH CARE
IN100165050AMedicaid
IN000000175431OtherANTHEM BLUE CROSS & BLUE
IN211700Medicare ID - Type UnspecifiedMEDICARE PROVIDER
IN100165050BMedicaid