| Mobile Van Service | |
|
1325 Jefferson Ave Memphis TN 38104-2013 | |
| (901) 701-2530 | |
| (901) 701-2536 |
| Full Name | Mobile Van Service |
|---|---|
| Speciality | Clinic/Center |
| Location | 1325 Jefferson Ave, Memphis, Tennessee |
| Authorized Official Name and Position | Shantelle Leatherwood (CEO) |
| Authorized Official Contact | 9012608551 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mobile Van Service 2595 Central Ave Memphis TN 38104-5905 Ph: (901) 260-8551 | Mobile Van Service 1325 Jefferson Ave Memphis TN 38104-2013 Ph: (901) 701-2530 |
| NPI Number | 1699922401 |
|---|---|
| Provider Enumeration Date | 08/22/2008 |
| Last Update Date | 09/17/2018 |
| Medicare PECOS PAC ID | 3870402084 |
|---|---|
| Medicare Enrollment ID | O20130415000054 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699922401 | NPI | - | NPPES |
| 3707256 | Other | TN | MEDICAID GROUP NUMBER |
| 3707256 | Other | TN | MEDICARE GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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