=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932196011
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN MOBILITY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8 SHACKLEFORD PLZ SUITE 316
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72211-1851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-716-2900
-----------------------------------------------------
Fax | 501-716-2904
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 SHACKLEFORD PLZ SUITE 316
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72211-1851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-716-2900
-----------------------------------------------------
Fax | 501-716-2904
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | JAMES GREG BUMPAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-716-2900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 23287760001
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------