Healthcare Provider Details

I. General information

NPI: 1669440392
Provider Name (Legal Business Name): SOPERS MOBILITY AIDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7392 N GOVERNMENT WAY
DALTON GARDENS ID
83815-8762
US

IV. Provider business mailing address

PO BOX 2344
HAYDEN ID
83835
US

V. Phone/Fax

Practice location:
  • Phone: 208-772-6474
  • Fax: 208-772-6797
Mailing address:
  • Phone: 208-772-6474
  • Fax: 208-772-6797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number59
License Number StateID

VIII. Authorized Official

Name: MRS. GENEVA J SOPER
Title or Position: OWNER MANAGER
Credential:
Phone: 208-772-6474