Provider Demographics
NPI:1932648607
Name:MOBILE DOC ALLIANCE LLC
Entity Type:Organization
Organization Name:MOBILE DOC ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MAI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-359-3998
Mailing Address - Street 1:2355 E CAMELBACK RD
Mailing Address - Street 2:STE 615
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3458
Mailing Address - Country:US
Mailing Address - Phone:480-359-3998
Mailing Address - Fax:480-385-6785
Practice Address - Street 1:2355 E CAMELBACK RD
Practice Address - Street 2:STE 615
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3458
Practice Address - Country:US
Practice Address - Phone:480-359-3998
Practice Address - Fax:480-385-6785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty