Basic Information
| Provider Information | |||||||||
| NPI: | 1285286229 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MOHR MEDICAL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 TURNBERRY CT N | ||||||||
| Address2: | |||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334621028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615126692 | ||||||||
| FaxNumber: | 5616128084 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 JFK DR STE 134 | ||||||||
| Address2: | |||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334621133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616128080 | ||||||||
| FaxNumber: | 5616128084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2019 | ||||||||
| LastUpdateDate: | 04/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MOHR | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5616128080 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 04/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 008849700 | 05 | FL | MEDICAID |