Mobile Medical Provider Inc

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

MOBILE MEDICAL PROVIDER INC

Practice address

12045 Bodley Place
Fishers, IN 46037-3714

Phone

(317) 588-1039

Fax

(317) 436-7002

NPI assigned

Apr 20, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Adeshola Abdulwahid Afolabi, NURSE PRACTITIONER

Title

President/Ceo

Phone

(317) 588-1039

Specialties & licenses 6

Addresses

Other identifiers 3

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

{
    "created_epoch": "1429488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597363200000",
    "number": "1659768356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12045 BODLEY PLACE",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460373714",
            "telephone_number": "317-588-1039",
            "fax_number": "317-436-7002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12045 BODLEY PLACE",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460373714",
            "telephone_number": "317-588-1039",
            "fax_number": "317-436-7002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE MEDICAL PROVIDER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-20",
        "last_updated": "2020-08-14",
        "certification_date": "2020-08-14",
        "status": "A",
        "authorized_official_last_name": "AFOLABI",
        "authorized_official_first_name": "ADESHOLA",
        "authorized_official_middle_name": "ABDULWAHID",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "317-588-1039",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "207QH0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084H0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "28204676A",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201176490",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000826011",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12544963",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Fishers, IN
• Providers in Fishers, IN by specialty
• Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2020; 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.