# MOBILE MEDICAL OPERATING COMPANY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mobile Medical
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245983022
- **Authorized official:** MR. ROBERT YOUNG (SECRETARY & CAO)
- **Authorized official phone:** (904) 733-1003

## Contact information

- **Practice address:** 1840 SE PORT ST LUCIE BLVD STE 1840, PORT ST LUCIE, FL 34952-5545
- **Practice address phone:** (772) 221-7620
- **Practice address fax:** (772) 221-9903
- **Mailing address:** 4655 SALISBURY RD STE 110, JACKSONVILLE, FL 32256-0957
- **Mailing address phone:** (904) 733-1003
- **Mailing address fax:** (904) 448-8855

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 02/01/2022
- **Last updated:** 09/25/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 117201700 | — | FL |
| 01 | — | 13404 | AHCA | FL |