Basic Information
| Provider Information | |||||||||
| NPI: | 1558382671 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOBILE SURGICAL SERVICES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6701 AIRPORT BLVD | ||||||||
| Address2: | SUITE D231 | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366086705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516334064 | ||||||||
| FaxNumber: | 2516330122 | ||||||||
| Practice Location | |||||||||
| Address1: | 6701 AIRPORT BLVD | ||||||||
| Address2: | SUITE D231 | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366086705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516334064 | ||||||||
| FaxNumber: | 2516330122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 12/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | LIGHTFOOT | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | MALCOLM | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2516334064 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 00026047 | AL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 00006907 | AL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 51523580 | 01 | AL | BCBS-RFH | OTHER | 1710151 | 01 | AL | UNITED HEALTHCARE-WML | OTHER | 51006999 | 01 | AL | BCBS-WML | OTHER | HW0099964115 | 05 | AL | MEDICAID | LI000006999 | 05 | AL | MEDICAID | P00157802 | 01 | AL | RAILROAD MEDICARE-RFH | OTHER | 3700108 | 01 | AL | UNITED HEALTHCARE-RFH | OTHER | 020038001 | 01 | AL | RAILROAD MEDICARE-WML | OTHER | CI2733 | 01 | AL | RAILROAD MEDICARE-GROUP | OTHER |