Healthcare Provider Details

I. General information

NPI: 1881623726
Provider Name (Legal Business Name): MOBILITY PLUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 S PARKHILL RD
TAHLEQUAH OK
74464-5235
US

IV. Provider business mailing address

1601 N MAIN ST
MUSKOGEE OK
74401-4451
US

V. Phone/Fax

Practice location:
  • Phone: 918-453-1177
  • Fax: 918-453-1194
Mailing address:
  • Phone: 918-686-0218
  • Fax: 918-684-7276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier100634600G
Identifier TypeMEDICAID
Identifier StateOK
Identifier Issuer

VIII. Authorized Official

Name: SCOTT A KNOWLES
Title or Position: EXECUTIVE GENERAL MANAGER
Credential:
Phone: 918-384-6779