MEDICARE: SOUTHWEST MOBILITY 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	332B00000X	Durable Medical Equipment & Medical Supplies	244	FL
2	332B00000X	Durable Medical Equipment & Medical Supplies	1312494	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R8619	OTHER	FL	BLUE CROSS BLUE SHIELD
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	:	1639114788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST MOBILITY INC.

Provider Business Mailing Address
First Line	:	1141 N DIXIE FWY
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-6069
Country	:	US
Telephone Number	:	386-426-2970
Fax Number	:	386-478-1399

Provider Business Practice Location Address
First Line	:	1141 N DIXIE FWY
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-6069
Country	:	US
Telephone Number	:	386-426-5069
Fax Number	:	386-426-6292

Authorized Official
Title or Position	:	SECRETARY
Name	:	MRS. SABRINA FARMER
Credential	:
Telephone Number	:	386-426-2970

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	08/10/2012

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