1669133443 NPI number — SOUTHERN MOBILITY SPECIALISTS INC

Table of content: (NPI 1669133443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669133443 NPI number — SOUTHERN MOBILITY SPECIALISTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN MOBILITY SPECIALISTS 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:
6
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:
1669133443
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 COUNTY ROAD 441
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38851-7642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-448-1179
Provider Business Mailing Address Fax Number:
662-448-1189

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
444 E PRESIDENT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUPELO
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38801-5500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-260-4870
Provider Business Practice Location Address Fax Number:
662-260-4764
Provider Enumeration Date:
01/04/2022

Additional Information

Authorized Official

Authorized Official Last Name:
GRIMES
Authorized Official First Name:
REGINA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
662-260-4870

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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