Provider Demographics
NPI:1356725485
Name:MOBILE HEALTH TEAM
Entity type:Organization
Organization Name:MOBILE HEALTH TEAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTORY
Authorized Official - Middle Name:
Authorized Official - Last Name:OKORIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-419-7820
Mailing Address - Street 1:6257 W. MCCORMICK BLVD
Mailing Address - Street 2:SUITE 134
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659
Mailing Address - Country:US
Mailing Address - Phone:773-234-1698
Mailing Address - Fax:
Practice Address - Street 1:6257 MCCORMICK BLVD
Practice Address - Street 2:STE 134
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-7463
Practice Address - Country:US
Practice Address - Phone:773-234-1698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041404508302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization