Healthcare Provider Details

I. General information

NPI: 1548481591
Provider Name (Legal Business Name): SIEBERT MOBILITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 SE MIEHE DRIVE SUITE 1
GRIMES IA
50111
US

IV. Provider business mailing address

3450 SE MIEHE DRIVE SUITE 1
GRIMES IA
50111
US

V. Phone/Fax

Practice location:
  • Phone: 515-986-3010
  • Fax: 515-986-3108
Mailing address:
  • Phone: 515-986-3010
  • Fax: 515-986-3108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier0729624
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: SHERRY MATTSON
Title or Position: OFFICE MGR
Credential:
Phone: 515-986-3010