MEDICARE: NORTHCOAST MOBILITY

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	:	1235550377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHCOAST MOBILITY

Provider Business Mailing Address
First Line	:	1281 ANDERSEN DR STE F
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-5335
Country	:	US
Telephone Number	:	415-457-1664
Fax Number	:	415-457-6206

Provider Business Practice Location Address
First Line	:	1281 ANDERSEN DR STE F
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-5335
Country	:	US
Telephone Number	:	415-457-1664
Fax Number	:	415-457-6206

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DENNIS LLOYD BREWER
Credential	:
Telephone Number	:	415-457-1664

Provider Enumeration Date	:	12/16/2013
Last Update Date	:	12/16/2013

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