1780749036 NPI number — MAXIMUM MOBILITY LLC

Table of content: (NPI 1780749036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780749036 NPI number — MAXIMUM MOBILITY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAXIMUM 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:
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:
1780749036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 N KEYSTONE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAYRE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18840-1403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-882-7436
Provider Business Mailing Address Fax Number:
570-882-7438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 N KEYSTONE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAYRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-882-7436
Provider Business Practice Location Address Fax Number:
570-882-7438
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KLOSSNER
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
GERARD
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
570-882-7436

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)

  • Identifier: 1024644040001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02987039 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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