MEDICARE: MOBILITY ADVANTAGE, INC.

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	:	1528251394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILITY ADVANTAGE, INC.

Provider Business Mailing Address
First Line	:	6634 TOPPER RUN STE 1
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78233-3894
Country	:	US
Telephone Number	:	210-599-1339
Fax Number	:	210-599-2771

Provider Business Practice Location Address
First Line	:	6634 TOPPER RUN STE 1
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78233-3894
Country	:	US
Telephone Number	:	210-599-1339
Fax Number	:	210-599-2771

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. GLADYS N. ANDERSON
Credential	:
Telephone Number	:	210-599-1339

Provider Enumeration Date	:	08/24/2007
Last Update Date	:	08/24/2007

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