Provider Demographics
NPI:1417359258
Name:ADVANCED MOBILE MD, LLC
Entity Type:Organization
Organization Name:ADVANCED MOBILE MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-810-5121
Mailing Address - Street 1:14201 N 87TH ST
Mailing Address - Street 2:D-145C
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3683
Mailing Address - Country:US
Mailing Address - Phone:480-443-1110
Mailing Address - Fax:602-753-9525
Practice Address - Street 1:14201 N 87TH ST
Practice Address - Street 2:D-145C
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3683
Practice Address - Country:US
Practice Address - Phone:480-443-1110
Practice Address - Fax:602-753-9525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty