Provider Demographics
NPI:1447838529
Name:SIMPLY HEALTH MOBILE CLINIC PLLC
Entity type:Organization
Organization Name:SIMPLY HEALTH MOBILE CLINIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NP-C
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-328-6521
Mailing Address - Street 1:2915 S HIGHWAY 281
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-1403
Mailing Address - Country:US
Mailing Address - Phone:840-328-9700
Mailing Address - Fax:
Practice Address - Street 1:2915 S HIGHWAY 281
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-1403
Practice Address - Country:US
Practice Address - Phone:940-328-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty