Healthcare Provider Details

I. General information

NPI: 1285668590
Provider Name (Legal Business Name): ULTIMATE MOBILITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1158 MAIN ST
WORCESTER MA
01603-2011
US

IV. Provider business mailing address

1158 MAIN ST
WORCESTER MA
01603-2011
US

V. Phone/Fax

Practice location:
  • Phone: 508-363-1227
  • Fax: 508-363-1228
Mailing address:
  • Phone: 508-363-1227
  • Fax: 508-363-1228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier1539086
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 2
Identifier98862301
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerNETWORK HEALTH PLAN
# 3
IdentifierEVERCARE
Identifier TypeOTHER
Identifier StateMA
Identifier Issuer8280484
# 4
Identifier0017588
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerNEIGHBORHOOD HEALTH PLAN
# 5
Identifier390654
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBCBSMA
# 6
Identifier685813
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS HEALTH PLAN
# 7
Identifier42615
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerFALLON COMMUNITY HEALTH

VIII. Authorized Official

Name: MR. WILLIAM MCCULLOUGH
Title or Position: TREASURER
Credential:
Phone: 508-363-1227