Mobile Medical Office

Primary specialty

Community Health Clinic/CenterTaxonomy code 261QC1500X

License

110000327 Issued in CA

Legal business name

MOBILE MEDICAL OFFICE

Practice address

1522 3Rd St
Eureka, CA 95501-0711

Phone

(707) 443-4666

Fax

(707) 443-6123

NPI assigned

Feb 20, 2007

Last updated

Jul 29, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Terri Lynn Clark

Title

Executive Director

Phone

(707) 443-4666

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1326183054. Details of each certification follow.

• CCN 551980 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 551980

Legal name

MOBILE MEDICAL OFFICE-MOBILE UNIT A

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jul 26, 2004

Last certification

Jul 26, 2004

Ownership / control type

For profit – partnership

Facility address

1522 Third Street
Eureka, CA 95501

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Paula Israel Rhude, F.N.P.

  • Family Nurse Practitioner
  • Eureka, CA
  • NPI 1790742534
  NPD (past)
• Wendy Susan Ring, MD

  • Family Medicine Physician
  • Eureka, CA
  • NPI 1639117716
  NPD (past)

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248825600000",
    "number": "1326183054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2020",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955022020",
            "telephone_number": "707-443-4666",
            "fax_number": "707-443-6123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1522 3RD ST",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955010711",
            "telephone_number": "707-443-4666",
            "fax_number": "707-443-6123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE MEDICAL OFFICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2009-07-29",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "TERRI",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "707-443-4666",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": "110000327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM03931G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bethany Miteiko, PA-C, DC
• Anil Mitra
• Jena Miyata
• Michael Bruce Mizoguchi, M.D.
• Luiza Mnatsakanyan, DO
• Diamond Charlotte Moebus
• Mohd Awwad ,DDS , Inc (victoria place dental center)
• Hailey Kristen Mohland Kopf
• Maya Mollier, DPT
• Dorothy Pugh Molofsky, RN PHN

• Community Health Clinic/Center in Eureka, CA
• Providers in Eureka, CA by specialty
• Community Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.