Healthcare Provider Details

I. General information

NPI: 1245407998
Provider Name (Legal Business Name): MABELINE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3136 MOUNT VERNON RD SE SUITE B
CEDAR RAPIDS IA
52403-3655
US

IV. Provider business mailing address

3136 MOUNT VERNON RD SE SUITE B
CEDAR RAPIDS IA
52403-3655
US

V. Phone/Fax

Practice location:
  • Phone: 319-363-3391
  • Fax: 319-364-8610
Mailing address:
  • Phone: 319-363-3391
  • Fax: 319-364-8610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1-57-016146
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier18351
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerWELLMARK BLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name: MR. JEFFREY SCOTT ABRAHAM SR.
Title or Position: PRESIDENT
Credential:
Phone: 319-363-3391