Provider Demographics
NPI:1154144178
Name:NORTHWOODS MOBILITY EQUIPMENT LLC
Entity type:Organization
Organization Name:NORTHWOODS MOBILITY EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:
Authorized Official - Last Name:MULQUEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-216-9646
Mailing Address - Street 1:701 CENTURY AVE
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-2473
Mailing Address - Country:US
Mailing Address - Phone:715-216-9646
Mailing Address - Fax:
Practice Address - Street 1:701 CENTURY AVE
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-2473
Practice Address - Country:US
Practice Address - Phone:715-216-9646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies