Provider Demographics
NPI:1144529579
Name:MOBILE PHYSICIAN SERVICES, PLLC
Entity type:Organization
Organization Name:MOBILE PHYSICIAN SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MONDAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-461-1874
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:TX
Mailing Address - Zip Code:75429-0306
Mailing Address - Country:US
Mailing Address - Phone:903-461-1874
Mailing Address - Fax:888-603-5315
Practice Address - Street 1:4101 WESLEY ST
Practice Address - Street 2:SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5635
Practice Address - Country:US
Practice Address - Phone:903-461-1874
Practice Address - Fax:888-603-5315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB127931OtherPTAN
TX1144529579OtherNPI
TX0041WNOtherBCBS