=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740375807
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHWEST MOBILITY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 09/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15458 N 99TH AVE
-----------------------------------------------------
City | SUN CITY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85351-1973
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-875-7296
-----------------------------------------------------
Fax | 623-875-8443
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4406 E MAIN ST STE 110
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85205-7910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-654-2292
-----------------------------------------------------
Fax | 480-654-2314
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | MR. MARK STEVEN FARMER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-654-2292
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 07381180X
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------