Healthcare Provider Details

I. General information

NPI: 1710244363
Provider Name (Legal Business Name): INDEPENDENT MOBILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18994 HIGHWAY 19
NEW LONDON MO
63459-4808
US

IV. Provider business mailing address

18994 HIGHWAY 19
NEW LONDON MO
63459-4808
US

V. Phone/Fax

Practice location:
  • Phone: 217-653-5031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PHILLIP BRENT COWDEN
Title or Position: PARTNER
Credential:
Phone: 217-653-5031