Healthcare Provider Details

I. General information

NPI: 1790667665
Provider Name (Legal Business Name): SEMO MOBILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 ROTH DR
SCOTT CITY MO
63780-8132
US

IV. Provider business mailing address

253 ROTH DR
SCOTT CITY MO
63780-8132
US

V. Phone/Fax

Practice location:
  • Phone: 573-986-8277
  • Fax:
Mailing address:
  • Phone: 573-986-8277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: QUINTON LACEY
Title or Position: OWNER
Credential:
Phone: 573-986-8277