Provider Demographics
NPI:1568127454
Name:MOBILE HELATH SERVICES OF INDIANA
Entity Type:Organization
Organization Name:MOBILE HELATH SERVICES OF INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:NIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-506-5961
Mailing Address - Street 1:11807 ALLISONVILLE RD STE 164
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2313
Mailing Address - Country:US
Mailing Address - Phone:317-506-5961
Mailing Address - Fax:
Practice Address - Street 1:239 ASH ST STE B
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IN
Practice Address - Zip Code:46072-1752
Practice Address - Country:US
Practice Address - Phone:317-506-5961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain