Provider Demographics
NPI:1609370774
Name:MOBILE PHYSICIANS TEAM LLC
Entity Type:Organization
Organization Name:MOBILE PHYSICIANS TEAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-298-6717
Mailing Address - Street 1:1225 HAVENDALE BLVD NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-1349
Mailing Address - Country:US
Mailing Address - Phone:863-298-6717
Mailing Address - Fax:863-298-6719
Practice Address - Street 1:1225 HAVENDALE BLVD NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-1349
Practice Address - Country:US
Practice Address - Phone:863-298-6717
Practice Address - Fax:863-298-6719
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOBILE PHYSICIANS TEAM MANAGEMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center