Provider Demographics
NPI:1730429770
Name:MOBILECARE
Entity type:Organization
Organization Name:MOBILECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC DIR
Authorized Official - Prefix:DR
Authorized Official - First Name:J W
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:479-636-0500
Mailing Address - Street 1:1222 W POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-4246
Mailing Address - Country:US
Mailing Address - Phone:479-636-0500
Mailing Address - Fax:479-636-6161
Practice Address - Street 1:1222 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-4246
Practice Address - Country:US
Practice Address - Phone:479-636-0500
Practice Address - Fax:479-636-6161
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SITUS CANCER RESEARCH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care