Provider Demographics
NPI:1750659447
Name:MOBILE INFIRMARY ASSOCIATION
Entity Type:Organization
Organization Name:MOBILE INFIRMARY ASSOCIATION
Other - Org Name:GULF HEALTH MANAGEMENT SERVICES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:NIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-435-7948
Mailing Address - Street 1:PO BOX 1468
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-1468
Mailing Address - Country:US
Mailing Address - Phone:251-435-7948
Mailing Address - Fax:251-435-6514
Practice Address - Street 1:1 MOBILE INFIRMARY CIR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3522
Practice Address - Country:US
Practice Address - Phone:251-435-7948
Practice Address - Fax:251-435-6514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336M0002X
AL1138353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL166519Medicaid