MEDICARE: UPLIFT 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	332BC3200X	Customized Equipment (DME)	1312078	FL

General Provider Information

NPI Number	:	1972660157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPLIFT MOBILITY, INC.

Provider Business Mailing Address
First Line	:	3606 US HIGHWAY 19
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-6257
Country	:	US
Telephone Number	:	727-842-4272
Fax Number	:	727-845-7520

Provider Business Practice Location Address
First Line	:	3606 US HIGHWAY 19
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-6257
Country	:	US
Telephone Number	:	727-842-4272
Fax Number	:	727-845-7520

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ABNER JIMENEZ
Credential	:
Telephone Number	:	727-842-4272

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	11/12/2007

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