MEDICARE: MEDICAL MOBILITY OF TEXAS, 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	0074794	TX

General Provider Information

NPI Number	:	1467459560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL MOBILITY OF TEXAS, LLC

Provider Business Mailing Address
First Line	:	2422 ARBUCKLE COURT
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-4506
Country	:	US
Telephone Number	:	214-239-2900
Fax Number	:	214-239-2905

Provider Business Practice Location Address
First Line	:	2422 ARBUCKLE COURT
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-4506
Country	:	US
Telephone Number	:	214-239-2900
Fax Number	:	214-239-2905

Authorized Official
Title or Position	:	CFO
Name	:	MS. JAN L. CLARK
Credential	:	CPA
Telephone Number	:	214-239-2900

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	08/22/2020

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