MEDICARE: MOTILITY MLK, 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	335E00000X	Prosthetic/Orthotic Supplier	CP2198	AR
2	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710363486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOTILITY MLK, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1966
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71902-1966
Country	:	US
Telephone Number	:	501-620-4800
Fax Number	:	848-272-8975

Provider Business Practice Location Address
First Line	:	120 HILL ST
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-6238
Country	:	US
Telephone Number	:	501-620-4800
Fax Number	:	848-272-8975

Authorized Official
Title or Position	:	CERTIFIED PROSTHETIST ORTHOTIST
Name	:	GREG JOHNSON
Credential	:	CPO
Telephone Number	:	479-305-9374

Provider Enumeration Date	:	08/05/2015
Last Update Date	:	06/01/2026

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Directions to “MOTILITY MLK, LLC ” Practice Location

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