Provider Demographics
NPI:1821665423
Name:MOBILE NP LLC
Entity Type:Organization
Organization Name:MOBILE NP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:513-560-2904
Mailing Address - Street 1:9996 BAUGHMAN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:OH
Mailing Address - Zip Code:45030-1714
Mailing Address - Country:US
Mailing Address - Phone:513-560-2904
Mailing Address - Fax:
Practice Address - Street 1:9996 BAUGHMAN RD
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030-1714
Practice Address - Country:US
Practice Address - Phone:513-560-2904
Practice Address - Fax:855-483-9360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1366070278Medicaid