# MOBILE MEDICAL PROVIDER INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659768356
- **Authorized official:** MR. ADESHOLA ABDULWAHID AFOLABI NURSE PRACTITIONER (PRESIDENT/CEO)
- **Authorized official phone:** (317) 588-1039

## Contact information

- **Practice address:** 12045 BODLEY PLACE, FISHERS, IN 46037-3714
- **Practice address phone:** (317) 588-1039
- **Practice address fax:** (317) 436-7002
- **Mailing address:** 12045 BODLEY PLACE, FISHERS, IN 46037-3714
- **Mailing address phone:** (317) 588-1039
- **Mailing address fax:** (317) 436-7002

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QH0002X | Hospice and Palliative Medicine (Family Medicine) Physician | — | NULL | — |
| 207QH0002X | Hospice and Palliative Medicine (Family Medicine) Physician | — | — | — |
| 207RH0002X | Hospice and Palliative Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RH0002X | Hospice and Palliative Medicine (Internal Medicine) Physician | — | — | — |
| 2084H0002X | Hospice and Palliative Medicine (Psychiatry & Neurology) Physician | — | NULL | — |
| 2084H0002X | Hospice and Palliative Medicine (Psychiatry & Neurology) Physician | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | 28204676A | IN | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 04/20/2015
- **Last updated:** 08/14/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000826011 | ANTHEM | IN |
| 01 | — | 12544963 | CAQH | IN |
| 05 | — | 201176490 | — | IN |