Healthcare Provider Details

I. General information

NPI: 1447668447
Provider Name (Legal Business Name): MOBILITY MARKETPLACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E 11TH AVE
COLUMBUS OH
43211-2607
US

IV. Provider business mailing address

625 E 11TH AVE
COLUMBUS OH
43211-2607
US

V. Phone/Fax

Practice location:
  • Phone: 614-486-8100
  • Fax:
Mailing address:
  • Phone: 614-486-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1102X
TaxonomyMilitary Outpatient Operational (Transportable) Component Clinic/Center
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. GERARD P SCHLEMBACH
Title or Position: OWNER
Credential:
Phone: 614-554-5857