MEDICARE: TUSK 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)
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1457966087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUSK MOBILITY LLC

Provider Business Mailing Address
First Line	:	9495 WINNETKA AVE N STE 200
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-1618
Country	:	US
Telephone Number	:	629-252-8211
Fax Number	:	763-255-3972

Provider Business Practice Location Address
First Line	:	4705 MCFARLAND BLVD STE 4
Second Line	:
City	:	NORTHPORT
State	:	AL
Zip	:	35476-2842
Country	:	US
Telephone Number	:	205-409-6619
Fax Number	:	205-409-6609

Authorized Official
Title or Position	:	SENIOR DIRECTOR OF PAYOR RELATIONS
Name	:	KILEY ANN RUSSELL
Credential	:
Telephone Number	:	629-252-8211

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	06/04/2026

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Directions to “TUSK MOBILITY LLC ” Practice Location

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