=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952741480
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A MEDI MOBILITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2013
-----------------------------------------------------
Last Update Date | 06/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 625 E MAIN ST
-----------------------------------------------------
City | SANTA MARIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93455-4505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-260-5389
-----------------------------------------------------
Fax | 805-347-7734
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 625 E MAIN ST
-----------------------------------------------------
City | SANTA MARIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93454-4505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-347-7717
-----------------------------------------------------
Fax | 805-347-7734
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PATRICIA ANN OKERBLOM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 805-260-5389
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number | D8170348
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------