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General NPI Number Information
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NPI Number | 1407497977
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Entity Type | Organization
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Legal Business Name | SOUTHERN MOBILITY SPECIALISTS INC
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Dates
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Enumeration Date | 10/04/2019
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 205 COUNTY ROAD 441
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City | HOUSTON
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State | MS
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Zip | 38851-7642
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Country | US
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Telephone | 662-448-1179
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Fax | 662-448-1189
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Provider Business Mailing Address
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Address Line | 205 COUNTY ROAD 441
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City | HOUSTON
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State | MS
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Zip | 38851-7642
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Country | US
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Telephone | 662-448-1179
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Fax | 662-448-1189
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. REGINA GRIMES
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Credential | PT, C/NDT, ATP
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Telephone | 662-448-1179
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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 |
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License Number State |
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