Basic Information
| Provider Information | |||||||||
| NPI: | 1053381020 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNITED SEATING AND MOBILITY LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NUMOTION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2070 LITTLE HILLS EXPY | ||||||||
| Address2: | |||||||||
| City: | SAINT CHARLES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633013708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144477500 | ||||||||
| FaxNumber: | 3144477830 | ||||||||
| Practice Location | |||||||||
| Address1: | 412 W DUSSEL DR | ||||||||
| Address2: | |||||||||
| City: | MAUMEE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435371686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198421300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 02/14/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | WALTER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING AND LICENSURE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3144477515 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | 332B00000X | 1228434 | OH | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 276581 | 01 | OH | AETNA NATIONAL-HMO | OTHER | 7282299 | 01 | OH | AETNA NATIONAL NON-HMO | OTHER | 1053381020 | 05 | MI | MEDICAID | 2268013 | 05 | OH | MEDICAID | 000000225965 | 01 | OH | ANTHEM BCBS OF OH | OTHER | 251910864 | 01 | OH | GREAT WEST LIFE & ANNUITY | OTHER | 04155 | 01 | OH | PARAMOUNT HEALTH PLAN | OTHER | 141330100 | 01 | OH | US DEPT. OF LABOR | OTHER | 14477 | 01 | MI | KIDS CARE OF MI | OTHER | 251910864 | 01 | MI | GREAT WEST LIFE & ANNUITY | OTHER | 407054 | 01 | MI | HUMANA CHOICE CARE | OTHER | 7282299 | 01 | MI | AETNA NATIONAL NON-HMO | OTHER | 141330100 | 01 | MI | US DEPT OF LABOR | OTHER | 20549 | 01 | MI | HEALTH PLAN OF MI | OTHER | 276581 | 01 | MI | AETNA-NATIONAL HMO | OTHER | 540H104210 | 01 | OH | BCBS OF MI | OTHER | 125235 | 01 | MI | GREAT LAKES HEALTH PLAN | OTHER | 407105 | 01 | OH | HUMANA CHOICE CARE | OTHER |