Provider Demographics
NPI: | 1922441195 |
---|---|
Name: | MEDICAL MOBILE SPECIALISTS S.C. |
Entity Type: | Organization |
Organization Name: | MEDICAL MOBILE SPECIALISTS S.C. |
Other - Org Name: | MOBILE MEDICAL SPECIALISTS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JEFFREY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | OSBOURNE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DPM |
Authorized Official - Phone: | 262-691-1000 |
Mailing Address - Street 1: | 347 PARK AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | PEWAUKEE |
Mailing Address - State: | WI |
Mailing Address - Zip Code: | 53072-3413 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 262-691-1000 |
Mailing Address - Fax: | 262-264-5429 |
Practice Address - Street 1: | 347 PARK AVE |
Practice Address - Street 2: | |
Practice Address - City: | PEWAUKEE |
Practice Address - State: | WI |
Practice Address - Zip Code: | 53072-3413 |
Practice Address - Country: | US |
Practice Address - Phone: | 262-691-1000 |
Practice Address - Fax: | 262-264-5429 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-04-08 |
Last Update Date: | 2013-04-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
No | 122300000X | Dental Providers | Dentist | Group - Multi-Specialty | |
No | 124Q00000X | Dental Providers | Dental Hygienist | Group - Multi-Specialty | |
No | 126800000X | Dental Providers | Dental Assistant | Group - Multi-Specialty | |
No | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Multi-Specialty | |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
No | 224L00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Pedorthist | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | Group - Multi-Specialty | |
No | 237700000X | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |