1730474990 NPI number — UNITED SEATING AND MOBILITY LLC

Table of content: (NPI 1730474990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730474990 NPI number — UNITED SEATING AND MOBILITY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED SEATING AND MOBILITY LLC
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:
1730474990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 BROOK ST STE 402
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKY HILL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06067-3431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-447-7500
Provider Business Mailing Address Fax Number:
314-447-7615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11979 STARCREST DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78247-4112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-696-1084
Provider Business Practice Location Address Fax Number:
210-579-1551
Provider Enumeration Date:
06/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING AND LICENSURE MANAGER
Authorized Official Telephone Number:
314-447-7515

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3001653-06 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3001653-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3001653-03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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