NPIMap

Organization Active NPI

Mobile County Board of Health

Doing business as Southwest Mobile Health Center

  • Federally Qualified Health Center (FQHC)
  • Mobile, AL
National Provider Identifier
1649523432
Registry record updated Apr 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MOBILE COUNTY BOARD OF HEALTH
Doing business as
Southwest Mobile Health Center
Practice address
5580 Inn Road
Mobile, AL 36619-1851
Phone
(251) 666-7413
Fax
(251) 666-7417
NPI assigned
Oct 18, 2012
Last updated
Apr 29, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2021

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

Authorized official

Name
Kelly Warren
Title
Executive Director
Phone
(251) 690-8158

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

5580 Inn Road
Mobile, AL 36619-1851

Mailing address

PO Box 2867
Mobile, AL 36652-2867
Phone (251) 690-8158

Other identifiers 1

IdentifierTypeStateIssuer
144632MedicaidAL

Other names 1

  • Southwest Mobile Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130219000555 AL Part A Provider - Federally Qualified Health Center (FQHC) 9931208386 Practice locations: Mobile, AL
O20180913000728 AL Part B Supplier - Clinic/Group Practice 9931208386 Receives reassigned benefits from 32 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mobile, AL; Semmes, AL; Mount Vernon, AL; Citronelle, AL; Bay Minette, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649523432. Details of each certification follow.

Federally qualified health center certification: CCN 011007

Legal name
MOBILE COUNTY BOARD OF HEALTH
Doing business as
MOBILE COUNTY HEALTH DEPARTMENT
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 30, 2013
Last certification
May 30, 2013
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
5580 Inn Road
Mobile, AL 36619-1851

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Mobile County Board of Health33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

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

View all 32

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kistra Scott Individual Corporate Officer Jan 1, 2017
Kathy Dunning Individual Corporate Officer Feb 1, 2017
Shantrell Nicks Individual Corporate Director Jan 1, 2020
Jolette Fischtzuir Individual Corporate Officer Jan 1, 2012
Dolores Harvey Individual Corporate Officer Jan 1, 2018
Kelly Warren Individual Corporate DirectorExecutive Director Nov 1, 2019
W-2 Managing EmployeeExecutive Director Nov 1, 2019
Carl Cunningham Individual Corporate Director Jan 1, 2020
Elige Jones Individual Corporate Officer Feb 1, 2017
George Gates Individual Corporate Director Jan 1, 2022
Julie McGee Individual Corporate OfficerChairperson Jan 1, 2013
April Davis Individual Corporate OfficerSecretary Mar 1, 2015
Cynthia Boykin Individual Corporate Director Jan 1, 2021
Kevin Michaels Individual Corporate OfficerHealth Officer Mar 2, 2022
Polly Rivers Individual Corporate OfficerVice Chairperson Jan 1, 2016
Mobile County Board of Health Organization, Mobile, AL Operational/Managerial Control Oct 15, 2012

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mobile County Health DepartmentMobile, AL, CCN 011846 Federally qualified health center Operational/Managerial Control Jun 3, 2015
Mobile County Health DepartmentCitronelle, AL, CCN 011856 Federally qualified health center Operational/Managerial Control May 1, 1991
Mobile County Health DepartmentMount Vernon, AL, CCN 011987 Federally qualified health center Operational/Managerial Control Feb 13, 2012
Mobile County Health DepartmentSemmes, AL, CCN 011988 Federally qualified health center Operational/Managerial Control Feb 13, 2012
Mobile County Health DepartmentMobile, AL, CCN 011986 Federally qualified health center Operational/Managerial Control Feb 13, 2012
Mobile County Health DepartmentMobile, AL, CCN 011019 Federally qualified health center Operational/Managerial Control May 1, 1991

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 6

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1350518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619654400000",
    "number": "1649523432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2867",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366522867",
            "telephone_number": "251-690-8158",
            "fax_number": "855-634-9302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5580 INN ROAD",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366191851",
            "telephone_number": "251-666-7413",
            "fax_number": "251-666-7417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE COUNTY BOARD OF HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-18",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A",
        "authorized_official_last_name": "WARREN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "251-690-8158"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "144632",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwest Mobile Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southwest Mobile Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mobile, AL

Sources for this page

Verify at the official NPI Registry.