Provider Demographics
NPI:1558045336
Name:MOBILE MEDICAL MISSION PLLC
Entity Type:Organization
Organization Name:MOBILE MEDICAL MISSION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERE
Authorized Official - Middle Name:HOWALD
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-205-2942
Mailing Address - Street 1:150 E DIVISION RD STE 1
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6997
Mailing Address - Country:US
Mailing Address - Phone:865-205-2942
Mailing Address - Fax:865-297-4917
Practice Address - Street 1:150 E DIVISION RD STE 1
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6997
Practice Address - Country:US
Practice Address - Phone:865-205-2942
Practice Address - Fax:865-297-4917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty