Provider Demographics
NPI:1558382671
Name:MOBILE SURGICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:MOBILE SURGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MALCOLM
Authorized Official - Last Name:LIGHTFOOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-633-4064
Mailing Address - Street 1:6701 AIRPORT BLVD
Mailing Address - Street 2:SUITE D231
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6705
Mailing Address - Country:US
Mailing Address - Phone:251-633-4064
Mailing Address - Fax:251-633-0122
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE D231
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:251-633-4064
Practice Address - Fax:251-633-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00006907208600000X
AL00026047208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51523580OtherBCBS-RFH
AL1710151OtherUNITED HEALTHCARE-WML
AL51006999OtherBCBS-WML
ALHW0099964115Medicaid
ALLI000006999Medicaid
ALP00157802OtherRAILROAD MEDICARE-RFH
AL3700108OtherUNITED HEALTHCARE-RFH
AL020038001OtherRAILROAD MEDICARE-WML
ALCI2733OtherRAILROAD MEDICARE-GROUP
ALC70833Medicare UPIN
AL051554928Medicare PIN
ALP00157802OtherRAILROAD MEDICARE-RFH
ALH40182Medicare UPIN