Healthcare Provider Details

I. General information

NPI: 1477877934
Provider Name (Legal Business Name): UNITED SEATING AND MOBILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 E FAIRVIEW AVE STE 150
MERIDIAN ID
83642-1846
US

IV. Provider business mailing address

805 BROOK ST STE 402
ROCKY HILL CT
06067-3431
US

V. Phone/Fax

Practice location:
  • Phone: 208-288-5460
  • Fax: 208-288-2844
Mailing address:
  • Phone: 314-447-7515
  • Fax: 855-375-7973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number003668305
License Number StateID

VIII. Authorized Official

Name: SONIA LEE VILLESCAS
Title or Position: SR LICENSING & CREDENTIALING MGR
Credential:
Phone: 314-447-7515