Provider Demographics
NPI:1700184389
Name:MOBILE MEDICAL HOME CARE INC
Entity Type:Organization
Organization Name:MOBILE MEDICAL HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BACKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-771-7798
Mailing Address - Street 1:10907 QUAKER AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-8315
Mailing Address - Country:US
Mailing Address - Phone:806-771-7798
Mailing Address - Fax:806-687-9299
Practice Address - Street 1:10907 QUAKER AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-8315
Practice Address - Country:US
Practice Address - Phone:806-771-7798
Practice Address - Fax:806-687-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty