Healthcare Provider Details

I. General information

NPI: 1942771258
Provider Name (Legal Business Name): MOBILITY 1 TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2018
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N MAIN ST # 3
BELLEVUE MI
49021-1231
US

IV. Provider business mailing address

123 N MAIN ST # 3
BELLEVUE MI
49021-1231
US

V. Phone/Fax

Practice location:
  • Phone: 269-430-5055
  • Fax: 269-430-5042
Mailing address:
  • Phone: 269-430-5055
  • Fax: 269-430-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. PAMELA A STEELE
Title or Position: GENERAL MANAGER
Credential: PH, VET, D-VET,
Phone: 269-763-2014