Healthcare Provider Details

I. General information

NPI: 1902647886
Provider Name (Legal Business Name): MOBICLINIX DME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 SERGEANT RD STE 134
SIOUX CITY IA
51106-4760
US

IV. Provider business mailing address

PO BOX 104
SERGEANT BLUFF IA
51054-0104
US

V. Phone/Fax

Practice location:
  • Phone: 888-315-3845
  • Fax: 712-248-8720
Mailing address:
  • Phone: 888-315-3845
  • Fax: 712-248-8720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE AMICK
Title or Position: MANAGER
Credential:
Phone: 888-315-3845