Provider Demographics
NPI:1588633325
Name:MOBILE CARE, INC
Entity Type:Organization
Organization Name:MOBILE CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:W
Authorized Official - Last Name:DEROUEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-346-0801
Mailing Address - Street 1:PO BOX 80735
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-0735
Mailing Address - Country:US
Mailing Address - Phone:281-346-0801
Mailing Address - Fax:281-346-0802
Practice Address - Street 1:110 HUGH WALLIS RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-2107
Practice Address - Country:US
Practice Address - Phone:337-289-5456
Practice Address - Fax:337-289-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0118190Medicaid
LA1677582Medicaid
LA00060242OtherSTATE EMPLOYEES GROUP
LAF0306OtherBLUE CROSS
LA0247848OtherUNITED HEALTH CARE
LA630000814OtherRAILROAD MEDICARE
LA0247848OtherUNITED HEALTH CARE
LA=========OtherPHYSICIANS MUTUAL
LA630000814OtherRAILROAD MEDICARE
LA1677582Medicaid