1730105958 NPI number — SOUTHWEST MOBILITY INCORPORATED

Table of content: (NPI 1730105958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730105958 NPI number — SOUTHWEST MOBILITY INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST MOBILITY INCORPORATED
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:
SCOOTER MOBILITY CENTER
Provider Other Organization Name Type Code:
3
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:
1730105958
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1972 STATE ROAD 44
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW SMYRNA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32168-8349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-426-5069
Provider Business Mailing Address Fax Number:
386-426-6292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
335 SEMORAN BLVD
Provider Second Line Business Practice Location Address:
SUITE 127
Provider Business Practice Location Address City Name:
FERN PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32730-2782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-975-0800
Provider Business Practice Location Address Fax Number:
407-975-0833
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FARMER
Authorized Official First Name:
SABRINA
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
386-426-2970

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: 022312300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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