Healthcare Provider Details

I. General information

NPI: 1750576914
Provider Name (Legal Business Name): PRINCEPAL MOBILITY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6733 NORTHWEST BLVD
DAVENPORT IA
52806-1558
US

IV. Provider business mailing address

6733 NORTHWEST BLVD
DAVENPORT IA
52806-1558
US

V. Phone/Fax

Practice location:
  • Phone: 563-445-0812
  • Fax: 563-388-4788
Mailing address:
  • Phone: 563-445-0812
  • Fax: 563-388-4788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier0284844
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: MR. GALEN SMITH
Title or Position: PRESIDENT
Credential:
Phone: 563-445-0812