Provider Demographics
NPI:1427167154
Name:MEDICAL MOBILITY, LLC
Entity type:Organization
Organization Name:MEDICAL MOBILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DALEN
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:SPAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-490-8485
Mailing Address - Street 1:10020 LIMA RD STE D
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-9144
Mailing Address - Country:US
Mailing Address - Phone:260-490-8485
Mailing Address - Fax:260-490-9874
Practice Address - Street 1:10020 LIMA RD STE D
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-9144
Practice Address - Country:US
Practice Address - Phone:260-490-8485
Practice Address - Fax:260-490-9874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5717120001Medicare ID - Type Unspecified