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General NPI Number Information
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NPI Number | 1215299227
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Entity Type | Organization
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Legal Business Name | OPEN ROAD MOBILITY, LLC
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 06/14/2012
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Provider Practice Location Address
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Address Line | 7411 82ND ST
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City | LUBBOCK
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State | TX
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Zip | 79424-4935
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Country | US
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Telephone | 806-771-5873
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Fax | 806-771-5874
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Provider Business Mailing Address
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Address Line | 7411 82ND ST
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City | LUBBOCK
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State | TX
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Zip | 79424-4935
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Country | US
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Telephone | 806-771-5873
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Fax | 806-771-5874
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. TINA GIBSON
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Credential |
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Telephone | 806-771-5873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | P108364M
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License Number State | TX
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