MEDICARE: MEDICAL 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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1427167154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL MOBILITY, LLC

Provider Business Mailing Address
First Line	:	10020 LIMA RD STE D
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-9144
Country	:	US
Telephone Number	:	260-490-8485
Fax Number	:	260-490-9874

Provider Business Practice Location Address
First Line	:	10020 LIMA RD STE D
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-9144
Country	:	US
Telephone Number	:	260-490-8485
Fax Number	:	260-490-9874

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MR. DALEN GENE SPAW
Credential	:
Telephone Number	:	260-490-8485

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	08/22/2020

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