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Contact Information

MOBILE MEDICAL PROVIDER INC
12045 BODLEY PLACE
FISHERS, IN46037-3714
 Phone: 317-588-1039
 Fax: 317-436-7002
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nurse Practitioner

363L00000X 50 Nurse Practitioner
 

Family

363LF0000X 50 Nurse Practitioner
 

Hospice and Palliative Medicine

207QH0002X 08 Physician/Family Practice
 

Hospice and Palliative Medicine

207RH0002X 11 Physician/Internal Medicine
 

Hospice and Palliative Medicine

2084H0002X 17 Physician/Hospice and Palliative Care
 

Psychiatric/Mental Health

363LP0808X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for MOBILE MEDICAL PROVIDER INC · (Female)

NPI # 1659768356
Status Active
Credentials
Entity Individual
Enumeration date 04/20/2015
Last updated 08/14/2020 - About 6 years ago
Sole proprietor 1 Not specified
Identifiers
  • IN License # 28204676A
  • IN Medicaid 201176490
  • IN Other 000000826011 ANTHEM
  • IN Other 12544963 CAQH
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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