Provider Demographics
NPI:1477385979
Name:MOBILEMEDIC OF TEXAS, PLLC
Entity type:Organization
Organization Name:MOBILEMEDIC OF TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN ASSISTANT
Authorized Official - Phone:801-520-7230
Mailing Address - Street 1:2733 TIMBER TRL
Mailing Address - Street 2:
Mailing Address - City:LUCAS
Mailing Address - State:TX
Mailing Address - Zip Code:75002-8809
Mailing Address - Country:US
Mailing Address - Phone:801-520-7230
Mailing Address - Fax:
Practice Address - Street 1:2733 TIMBER TRL
Practice Address - Street 2:
Practice Address - City:LUCAS
Practice Address - State:TX
Practice Address - Zip Code:75002-8809
Practice Address - Country:US
Practice Address - Phone:801-520-7230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty