Provider Demographics
NPI:1861056921
Name:MOBILE PHYSICIAN SERVICES INC.
Entity type:Organization
Organization Name:MOBILE PHYSICIAN SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:WACKSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-232-0644
Mailing Address - Street 1:6804 CECELIA DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-4935
Mailing Address - Country:US
Mailing Address - Phone:855-232-0644
Mailing Address - Fax:888-546-0488
Practice Address - Street 1:4031 COLONEL GLENN HWY STE 133
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45431-2774
Practice Address - Country:US
Practice Address - Phone:855-232-0644
Practice Address - Fax:888-546-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain