Provider Demographics
NPI:1417187261
Name:MOBILE MEDICS ANCILLARY SERVICES INC
Entity Type:Organization
Organization Name:MOBILE MEDICS ANCILLARY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MUKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:WADHWA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:954-562-5855
Mailing Address - Street 1:10423 S BARNSLEY DR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-4471
Mailing Address - Country:US
Mailing Address - Phone:954-562-5855
Mailing Address - Fax:954-775-0019
Practice Address - Street 1:10423 S BARNSLEY DR
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-4471
Practice Address - Country:US
Practice Address - Phone:954-562-5855
Practice Address - Fax:954-775-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14086225100000X
FL9165576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY03VKOtherBCBS
FL9239596OtherAETNA