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General NPI Number Information
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NPI Number | 1316051022
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Entity Type | Organization
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Legal Business Name | MOVIN ON MOBILITY MID AMERICA LLC
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 3301 FERN VALLEY RD
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City | LOUISVILLE
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State | KY
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Zip | 40213-3527
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Country | US
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Telephone | 502-964-3556
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Fax | 502-964-0159
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Provider Business Mailing Address
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Address Line | 3301 FERN VALLEY RD
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City | LOUISVILLE
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State | KY
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Zip | 40213-3527
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Country | US
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Telephone | 502-964-3556
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Fax | 502-964-0159
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Authorized Official
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Title or Position | MANAGER/PARTNER
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Name | MR. JOE SHROAT
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Credential |
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Telephone | 502-964-3556
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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 | 69000409A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 105879
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License Number State | KY
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