=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144115940
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEAM W MOBILITY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2025
-----------------------------------------------------
Last Update Date | 06/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5532 W RAYMOND ST
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46241-4341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-286-6793
-----------------------------------------------------
Fax | 833-566-2454
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5532 W RAYMOND ST
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46241-4341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-286-6793
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MOBILITY CONSULTANT
-----------------------------------------------------
Name | MR. STODDARD WORMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-286-6793
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------