Provider Demographics
NPI:1962428383
Name:MOBILE PROSTHETICS, INC.
Entity type:Organization
Organization Name:MOBILE PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EINAR
Authorized Official - Middle Name:O
Authorized Official - Last Name:OLLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:727-726-6178
Mailing Address - Street 1:1006 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-2113
Mailing Address - Country:US
Mailing Address - Phone:727-726-6178
Mailing Address - Fax:727-937-2831
Practice Address - Street 1:1006 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-2113
Practice Address - Country:US
Practice Address - Phone:727-726-6178
Practice Address - Fax:727-937-2831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPRO64335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0324850001Medicare NSC