Healthcare Provider Details

I. General information

NPI: 1932154622
Provider Name (Legal Business Name): ADVANCED MOBILITY SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 E MAIN ST
BARTOW FL
33830-4718
US

IV. Provider business mailing address

465 E MAIN ST
BARTOW FL
33830-4718
US

V. Phone/Fax

Practice location:
  • Phone: 863-533-3666
  • Fax: 863-534-8647
Mailing address:
  • Phone: 863-533-3666
  • Fax: 863-534-8647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1896
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number1896
License Number StateFL

VIII. Authorized Official

Name: JAMI JENKINS
Title or Position: DIRECTOR
Credential:
Phone: 863-533-3666