Mobile Medical Practitioners

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA053291 Issued in PA

Legal business name

MOBILE MEDICAL PRACTITIONERS

Practice address

111 Presidential Blvd Ste 165
Bala Cynwyd, PA 19004-1005

Phone

(215) 701-8153

NPI assigned

Jan 6, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Lance K Johnson

Title

Owner

Phone

(215) 701-8153

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1388966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388966400000",
    "number": "1265854509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 PRESIDENTIAL BLVD STE 165",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190041005",
            "telephone_number": "215-701-8153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 PRESIDENTIAL BLVD STE 165",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190041005",
            "telephone_number": "215-701-8153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE MEDICAL PRACTITIONERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-06",
        "last_updated": "2014-01-06",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "LANCE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-701-8153",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA053291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Ann Miller, PT, DPT
• Mindset Over Matter Therapeutic Services
• Eduardo Minsk, D.M.D.
• Jennifer Mirel
• Dorian James Mitchell, MS, LBS
• Mobile Physician Group PC
• Moisture Master Pros
• Samaneh Mojarrad, DMD, MS
• Brian Monk, LBS
• Carol Moog, PHD

• Physician Assistant in Bala Cynwyd, PA
• Providers in Bala Cynwyd, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.