Provider Demographics
NPI:1790286367
Name:MOBILE MEDICAL GROUP PC
Entity Type:Organization
Organization Name:MOBILE MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASHMA THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:801-835-8930
Mailing Address - Street 1:450 S 900 E STE 150
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2959
Mailing Address - Country:US
Mailing Address - Phone:801-835-8930
Mailing Address - Fax:801-981-8522
Practice Address - Street 1:450 S 900 E STE 150
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2959
Practice Address - Country:US
Practice Address - Phone:801-835-8930
Practice Address - Fax:801-981-8522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty