MEDICARE: AUTOFARM MOBILITY,LLC

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	196751	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000281743	OTHER	IN	BCR PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285636373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTOFARM MOBILITY,LLC

Provider Business Mailing Address
First Line	:	810 W MILL ST
Second Line	:
City	:	MIDDLETOWN
State	:	IN
Zip	:	47356-1028
Country	:	US
Telephone Number	:	765-354-2261
Fax Number	:	765-354-6604

Provider Business Practice Location Address
First Line	:	810 W MILL ST
Second Line	:
City	:	MIDDLETOWN
State	:	IN
Zip	:	47356-1028
Country	:	US
Telephone Number	:	765-354-2261
Fax Number	:	765-354-6604

Authorized Official
Title or Position	:	CO-PRESIDENT
Name	:	MR. JAMES KISSLING
Credential	:
Telephone Number	:	765-354-2261

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	12/17/2014

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