Healthcare Provider Details

I. General information

NPI: 1689675217
Provider Name (Legal Business Name): MOBILITY EXPRESS OF SCRANTON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S MAIN AVE
SCRANTON PA
18504-2266
US

IV. Provider business mailing address

405 S MAIN AVE
SCRANTON PA
18504-2266
US

V. Phone/Fax

Practice location:
  • Phone: 570-344-6555
  • Fax: 570-344-2699
Mailing address:
  • Phone: 570-344-6555
  • Fax: 570-344-2699

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
Identifier040041800
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLACK LUNG PROVIDER
# 2
Identifier601 362 100
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPA DEPT OF LABOR PROVIDER
# 3
Identifier0078245180002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. LOU DIBILEO JR.
Title or Position: OWNER
Credential:
Phone: 570-344-6555