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General NPI Number Information
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NPI Number | 1669440392
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Entity Type | Organization
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Legal Business Name | SOPERS MOBILITY AIDS LLC
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 02/23/2015
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Provider Practice Location Address
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Address Line | 7392 N GOVERNMENT WAY
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City | DALTON GARDENS
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State | ID
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Zip | 83815-8762
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Country | US
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Telephone | 208-772-6474
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Fax | 208-772-6797
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Provider Business Mailing Address
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Address Line | PO BOX 2344
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City | HAYDEN
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State | ID
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Zip | 83835
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Country | US
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Telephone | 208-772-6474
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Fax | 208-772-6797
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Authorized Official
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Title or Position | OWNER MANAGER
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Name | MRS. GENEVA J SOPER
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Credential |
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Telephone | 208-772-6474
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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 | 59
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License Number State | ID
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