Healthcare Provider Details

I. General information

NPI: 1821042136
Provider Name (Legal Business Name): INDEPENDENT MOBILITY PLUS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N MILITARY AVE SUITE #7
GREEN BAY WI
54303-4570
US

IV. Provider business mailing address

450 N MILITARY AVE SUITE #7
GREEN BAY WI
54303-4570
US

V. Phone/Fax

Practice location:
  • Phone: 920-965-6000
  • Fax: 920-491-0527
Mailing address:
  • Phone: 920-965-6000
  • Fax: 920-491-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: EVAN PARKER
Title or Position: OWNER / PRESIDENT
Credential:
Phone: 920-965-6000