Provider Demographics
NPI:1770239162
Name:SOS MOBILE MEDICAL CARE LLC
Entity Type:Organization
Organization Name:SOS MOBILE MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KOLANKO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:813-226-3332
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-0022
Mailing Address - Country:US
Mailing Address - Phone:813-226-3332
Mailing Address - Fax:813-793-7644
Practice Address - Street 1:16025 MUIRFIELD DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-2861
Practice Address - Country:US
Practice Address - Phone:813-226-3332
Practice Address - Fax:813-793-7644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care