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General NPI Number Information
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NPI Number | 1104087055
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Entity Type | Organization
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Legal Business Name | MOBILITY MEDICAL SUPPLY
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 630 MURPHY RD STE 113
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City | STAFFORD
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State | TX
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Zip | 77477-5928
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Country | US
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Telephone | 832-880-1988
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Fax |
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Provider Business Mailing Address
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Address Line | 630 MURPHY RD STE 113
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City | STAFFORD
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State | TX
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Zip | 77477-5928
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CALLISTUS C EDOZIE
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Credential |
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Telephone | 832-880-1988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0089210
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License Number State | TX
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