=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992661110
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AJ MOBILITY REPAIR LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2025
-----------------------------------------------------
Last Update Date | 12/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 844 S RIVERSIDE AVE
-----------------------------------------------------
City | MEDFORD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97501-7849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-821-1499
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 844 S RIVERSIDE AVE
-----------------------------------------------------
City | MEDFORD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97501-7849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-821-1499
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANTHONY FRANCISCO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 541-821-7342
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374700000X
-----------------------------------------------------
Taxonomy Name | Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------