Healthcare Provider Details

I. General information

NPI: 1982786117
Provider Name (Legal Business Name): SHOW ME MOBILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 HIGHWAY 72 EAST
ROLLA MO
65401
US

IV. Provider business mailing address

1214 HWY 72 E
ROLLA MO
65401
US

V. Phone/Fax

Practice location:
  • Phone: 573-364-2524
  • Fax: 573-426-6383
Mailing address:
  • Phone: 573-364-2524
  • Fax: 573-426-6383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier626322200
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name: MRS. TINA M SANDS
Title or Position: OWNER
Credential:
Phone: 573-368-1459