Organization
MOBILE MD HOLDINGS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA CANTWELL (EXECUTIVE DIRECTOR)
(502) 253-4140
Entity
Organization
Contact information
Practice address
9510 ORMSBY STATION ROAD, SUITE 100B, LOUISVILLE, KY 40223-4082
(502) 253-4140
Mailing address
9510 ORMSBY STATION RD, SUITE 100B, LOUISVILLE, KY 40223-4081
(502) 253-4140
(502) 253-4144
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
720224
KY
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65944530
—
KY
05
—
78904810
—
KY
Enumeration date
11/06/2006
Last updated
03/12/2009
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