Basic Information
| Provider Information | |||||||||
| NPI: | 1033302187 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATG DESIGNING MOBILITY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2070 LITTLE HILLS EXPY | ||||||||
| Address2: | |||||||||
| City: | SAINT CHARLES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633013708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144477500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 215 W PALM AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | BURBANK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 915021865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188461371 | ||||||||
| FaxNumber: | 8184410080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2007 | ||||||||
| LastUpdateDate: | 07/24/2020 | ||||||||
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| AuthorizedOfficialLastName: | PIVAR | ||||||||
| AuthorizedOfficialFirstName: | JACK | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | VP/GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 5184750837 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 07/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 46259 | CA | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BC3200X | 46259 | CA | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
No ID Information.