1790755742 NPI number — UNITED SEATING AND MOBILITY

Table of content: (NPI 1790755742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790755742 NPI number — UNITED SEATING AND MOBILITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED SEATING AND MOBILITY
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:
1790755742
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2023
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:
314-447-7830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2030 N HIGHWAY 360
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND PRAIRIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75050-1423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-377-2225
Provider Business Practice Location Address Fax Number:
817-377-2250
Provider Enumeration Date:
01/24/2006

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 , with the licence number:  07088917 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 145456301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10006343 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 251910864 . This is a "GREAT WEST LIFE & ANNUITY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 276581 . This is a "AETNA NATIONAL HMO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 017600-01 . This is a "PACIFICARE OF TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1444655-03 . This is a "CSHCN NON-CUSTOM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 145457101 . This is a "SUPERIOR HEALTH PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 531032 . This is a "BCBS OF TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10465 . This is a "PARKLAND COMMUNITY HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 141330100 . This is a "US DEPT. OF LABOR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1444655-02 . This is a "CSHCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 144465504 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145457101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 407109 . This is a "HUMANA CHOICE CARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7282299 . This is a "AETNA NATIONAL NON-HMO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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