MEDICARE: EXTREME 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	332BC3200X	Customized Equipment (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	45003910	OTHER	KY	EPSDT

General Provider Information

NPI Number	:	1194923557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXTREME MOBILITY INC.

Provider Business Mailing Address
First Line	:	2551 REGENCY RD
Second Line	:	SUITE 105
City	:	LEXINGTON
State	:	KY
Zip	:	40503-2963
Country	:	US
Telephone Number	:	859-277-0105
Fax Number	:

Provider Business Practice Location Address
First Line	:	2551 REGENCY RD
Second Line	:	SUITE 105
City	:	LEXINGTON
State	:	KY
Zip	:	40503-2963
Country	:	US
Telephone Number	:	859-277-0105
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID ADAIR
Credential	:
Telephone Number	:	859-277-0105

Provider Enumeration Date	:	07/06/2007
Last Update Date	:	11/21/2008

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