Mobile Wound Care & Multi-Specialty Medical Group

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

MOBILE WOUND CARE & MULTI-SPECIALTY MEDICAL GROUP

Practice address

1425 W Manchester Ave Ste a
Los Angeles, CA 90047-5436

Phone

(626) 869-6050

NPI assigned

Apr 29, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Daniel Shane Davidson, MD

Title

Ceo

Phone

(310) 212-1500

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Emery Cason Jamerson

  • Ophthalmology Physician
  • Riverside, CA
  • NPI 1770042962
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714348800000",
    "number": "1093561938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1270 S ALFRED ST UNIT 1064",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900352506",
            "telephone_number": "310-212-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 W MANCHESTER AVE STE A",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900475436",
            "telephone_number": "626-869-6050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE WOUND CARE & MULTI-SPECIALTY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-29",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "SHANE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-212-1500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mobile Home Health Palliative & Hospice Medical Group
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• Mobile MRI Services,Inc.
• Mobile Radiological Services, Inc
• Mobile Teeth Cleaning
• Mobile2U
• Mobility Plus Transportation LLC
• Emerald Cheri Mobley
• Jeannie Moc Herrera
• Ivan Moc

• Multi-Specialty Clinic/Center in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Multi-Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.