MEDICARE: INDEPENDENT MOBILITY ENTERPRISES

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

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	49839	OTHER	AR	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1245352244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT MOBILITY ENTERPRISES

Provider Business Mailing Address
First Line	:	129 S BRIARWOOD DR
Second Line	:
City	:	SHERIDAN
State	:	AR
Zip	:	72150-8417
Country	:	US
Telephone Number	:	870-942-3270
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 S BRIARWOOD DR
Second Line	:
City	:	SHERIDAN
State	:	AR
Zip	:	72150-8417
Country	:	US
Telephone Number	:	870-942-3270
Fax Number	:

Authorized Official
Title or Position	:	ADM/OWNER
Name	:	MRS. SHARON JUSTICE CLINTON
Credential	:
Telephone Number	:	870-942-3270

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	08/05/2008

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