Healthcare Provider Details

I. General information

NPI: 1699581868
Provider Name (Legal Business Name): TWC MOBILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5203 W 73RD ST
EDINA MN
55439-2206
US

IV. Provider business mailing address

1677 WINDSOR DR S
SHAKOPEE MN
55379-7074
US

V. Phone/Fax

Practice location:
  • Phone: 612-217-4040
  • Fax:
Mailing address:
  • Phone: 612-217-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL CONDON
Title or Position: OWNER
Credential:
Phone: 612-217-4040