MEDICARE: MODERN MOBILITY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1144224940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN MOBILITY, INC.

Provider Business Mailing Address
First Line	:	849 VIRGINIA BEACH BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-4235
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	849 VIRGINIA BEACH BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-4235
Country	:	US
Telephone Number	:	757-437-2501
Fax Number	:	757-437-2503

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. GAIL SPARKS
Credential	:
Telephone Number	:	757-437-2501

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	08/22/2020

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