Provider Demographics
NPI:1760447866
Name:MOBILE-SC, LTD
Entity Type:Organization
Organization Name:MOBILE-SC, LTD
Other - Org Name:MOBILE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:LEA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARBOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-545-2572
Mailing Address - Street 1:6144 AIRPORT BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3143
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6144 AIRPORT BLVD STE A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3143
Practice Address - Country:US
Practice Address - Phone:251-438-3614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000055034Medicare PIN