Healthcare Provider Details

I. General information

NPI: 1144077090
Provider Name (Legal Business Name): YOUR MOBILE COSMO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 MARKET ST
YOUNGSTOWN OH
44512-5621
US

IV. Provider business mailing address

940 COMPASS WEST DR
YOUNGSTOWN OH
44515-3440
US

V. Phone/Fax

Practice location:
  • Phone: 866-897-4301
  • Fax:
Mailing address:
  • Phone: 330-787-7911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: KANISHA TEEMER
Title or Position: CEO
Credential: CPS
Phone: 866-897-4301