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General NPI Number Information
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NPI Number | 1134298649
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Entity Type | Organization
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Legal Business Name | EXTREME MOBILITY MEDICAL SUPPLY, INC.
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 7858 N ACADEMY BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-3920
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Country | US
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Telephone | 719-265-5225
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Fax | 719-265-6065
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Provider Business Mailing Address
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Address Line | 7858 N ACADEMY BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-3920
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Country | US
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Telephone | 719-265-5225
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Fax | 719-265-6065
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL VANHART
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Credential |
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Telephone | 719-265-5225
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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 | 20061344781
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License Number State | CO
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