Provider Demographics
NPI:1720730187
Name:BROWN FAMILY MEDICAL MOBILE SERVICES
Entity Type:Organization
Organization Name:BROWN FAMILY MEDICAL MOBILE SERVICES
Other - Org Name:BROWN FAMILY MEDICAL MOBILE SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VASHONDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FOUST-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:336-269-7803
Mailing Address - Street 1:806 GREEN VALLEY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7076
Mailing Address - Country:US
Mailing Address - Phone:336-753-3215
Mailing Address - Fax:
Practice Address - Street 1:503 HAWTHORN RIDGE DR
Practice Address - Street 2:
Practice Address - City:WHITSETT
Practice Address - State:NC
Practice Address - Zip Code:27377-9345
Practice Address - Country:US
Practice Address - Phone:336-753-3215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service