NPI Record of MOBILE PHYSICIAN SERVICES INC. NPI 1003002759

Internal Medicine (Hospice and Palliative Medicine) in New Port Richey, FL

Complete NPI Record

Field Name Value Definition
NPI1003002759The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameMOBILE PHYSICIAN SERVICES INC.The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address6804 CECELIA DRThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City NameNEW PORT RICHEYThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameFLThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code346534935The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number8552320644The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number8885460488The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address6804 CECELIA DRThe first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameNEW PORT RICHEYThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameFLThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code346534935The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number7272320644The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number8885460488The fax number associated with the location address of the provider being identified.
Provider Enumeration Date9/17/2007The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date2/18/2021The date that a record was last updated or changed.
Authorized Official Last NameWACKSMANThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameRICHARDThe first name of the authorized official.
Authorized Official Middle NameMThe middle name of the authorized official.
Authorized Official Title or PositionMEDICAL DIRECTORThe title or position of the authorized official.
Authorized Official Telephone Number8552320644The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1363LA2200XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1N
Healthcare Provider Taxonomy Code 2152W00000X
Healthcare Provider Primary Taxonomy Switch 2N
Healthcare Provider Taxonomy Code 3207R00000X
Provider License Number 3ME0086161The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 3FLThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3N
Healthcare Provider Taxonomy Code 42084P0805X
Healthcare Provider Primary Taxonomy Switch 4N
Healthcare Provider Taxonomy Code 5213ES0103X
Healthcare Provider Primary Taxonomy Switch 5N
Healthcare Provider Taxonomy Code 6207RH0002X
Healthcare Provider Primary Taxonomy Switch 6Y
Other Provider Identifier 1MEDICARE NPIAdditional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 101Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1FL
Other Provider Identifier Issuer 11003002759
Other Provider Identifier 2000MQAdditional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 201Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2FL
Other Provider Identifier Issuer 2BCBS GROUP
Other Provider Identifier 3007870000Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 305Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3FL
Other Provider Identifier 4K9757AAdditional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 401Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4FL
Other Provider Identifier Issuer 4FL PTAN
Other Provider Identifier 50404354Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 505Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 5OH
Other Provider Identifier 6K9757Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 601Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 6FL
Other Provider Identifier Issuer 6PTAN
Is Organization SubpartN
Authorized Official Name Prefix TextDR.
Authorized Official Credential TextM.D.
Healthcare Provider Taxonomy Group 1193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 3193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 4193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 5193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 6193200000X MULTI-SPECIALTY GROUP
NPI Certification Date2/18/2021