Provider Demographics
NPI:1730999889
Name:MOBILE STAT CLINIC
Entity type:Organization
Organization Name:MOBILE STAT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ADOLPHUS
Authorized Official - Last Name:MEADE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:619-846-6240
Mailing Address - Street 1:249 S HIGHWAY 101 UNIT 229
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1807
Mailing Address - Country:US
Mailing Address - Phone:619-846-6240
Mailing Address - Fax:
Practice Address - Street 1:1596 N COAST HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1446
Practice Address - Country:US
Practice Address - Phone:213-373-1667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No261QM1000XAmbulatory Health Care FacilitiesClinic/CenterMigrant Health
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care