1417920067 NPI number — NATIONAL SEATING & MOBILITY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417920067 NPI number — NATIONAL SEATING & MOBILITY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONAL SEATING & MOBILITY, 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:
Provider Other Organization Name Type Code:
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:
1417920067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5959 SHALLOWFORD RD
Provider Second Line Business Mailing Address:
SUITE 443
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37241-2245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-756-2268
Provider Business Mailing Address Fax Number:
423-266-9690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25608 I-30 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYANT
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72022-9357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-568-7688
Provider Business Practice Location Address Fax Number:
501-568-6737
Provider Enumeration Date:
02/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MATUKEWICZ
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
423-756-2268

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 001298 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100794550B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 140980716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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