1689675217 NPI number — MOBILITY EXPRESS OF SCRANTON, INC.

Table of content: (NPI 1689675217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689675217 NPI number — MOBILITY EXPRESS OF SCRANTON, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILITY EXPRESS OF SCRANTON, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MOBILITY EXPRESS
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689675217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 S MAIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCRANTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18504-2266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-344-6555
Provider Business Mailing Address Fax Number:
570-344-2699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 S MAIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18504-2266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-344-6555
Provider Business Practice Location Address Fax Number:
570-344-2699
Provider Enumeration Date:
08/04/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DIBILEO
Authorized Official First Name:
LOU
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
570-344-6555

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 040041800 . This is a "BLACK LUNG PROVIDER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 601 362 100 . This is a "PA DEPT OF LABOR PROVIDER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0078245180002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".