1356390702 NPI number — MOBILITY MEDICAL OF NORTH

Table of content: (NPI 1356390702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356390702 NPI number — MOBILITY MEDICAL OF NORTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILITY MEDICAL OF NORTH
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 MEDICAL
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:
1356390702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
554 PARK LN
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
FLOWOOD
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39232-8895
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-932-1001
Provider Business Mailing Address Fax Number:
601-932-2130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2565 HALLS MILL RD
Provider Second Line Business Practice Location Address:
UNIT F
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-932-1001
Provider Business Practice Location Address Fax Number:
601-932-2130
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARROLL
Authorized Official First Name:
DANYELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/OWNER
Authorized Official Telephone Number:
601-932-1001

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  25882 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1406 . This is a "AL BOARD OF HME SVS PROVIDERS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 200655 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0695311.1 . This is a "MS BOARD OF PHARMACY PERMIT" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: DME.000555 . This is a "LA STATE LICENSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 03630512 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020865400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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