NPIMap

Organization Active NPI

Mobile Healthcare Providers Northwest

  • Family Medicine Physician
  • Vancouver, WA
National Provider Identifier
1306235049
Registry record updated Jan 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MOBILE HEALTHCARE PROVIDERS NORTHWEST
Practice address
415 SE 177TH Ave
Vancouver, WA 98683-4201
Phone
(360) 980-2441
Fax
(877) 491-4990
NPI assigned
Jan 19, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2022

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

Authorized official

Name
Mary Buckland, APRN, FNP-BCNPI 1912066986
Title
Owner
Phone
(360) 773-7463

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X

Addresses

Primary practice location

415 SE 177TH Ave
Vancouver, WA 98683-4201

Mailing address

PO Box 728
Camas, WA 98607-0728
Phone (360) 980-2441

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190313002494 WA Part B Supplier - Clinic/Group Practice 5496095283 Receives reassigned benefits from 8 practitioners
Practice locations: Vancouver, WA

National Provider Directory

National Provider Directory
Tax ID family
Mobile Healthcare Providers Northwest2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

418 SE 177TH Ave
Vancouver, WA 98683

415 SE 117th Ave
Vancouver, WA 98683
Phone (360) 448-1012

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1421625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643155200000",
    "number": "1306235049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 728",
            "city": "CAMAS",
            "state": "WA",
            "postal_code": "986070728",
            "telephone_number": "360-980-2441",
            "fax_number": "360-831-0047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 SE 177TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986834201",
            "telephone_number": "360-980-2441",
            "fax_number": "877-491-4990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE HEALTHCARE PROVIDERS NORTHWEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-19",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A",
        "authorized_official_last_name": "BUCKLAND",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-773-7463",
        "authorized_official_credential": "APRN, FNP-BC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; 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.