Provider Demographics
NPI:1427123710
Name:CAMBRIDGE MED MOBILITY LLC
Entity type:Organization
Organization Name:CAMBRIDGE MED MOBILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUCIANO
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHETAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:770-772-7373
Mailing Address - Street 1:4555 MANSELL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8279
Mailing Address - Country:US
Mailing Address - Phone:770-772-7373
Mailing Address - Fax:
Practice Address - Street 1:4555 MANSELL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-8279
Practice Address - Country:US
Practice Address - Phone:770-772-7373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA303697797332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5892390001Medicare NSC