Basic Information
| Provider Information | |||||||||
| NPI: | 1225308596 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOBILITY SOLUTIONS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1536 | ||||||||
| Address2: | |||||||||
| City: | MANDEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704701536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856356943 | ||||||||
| FaxNumber: | 9856356948 | ||||||||
| Practice Location | |||||||||
| Address1: | 19411 HELENBERG RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704335199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856356943 | ||||||||
| FaxNumber: | 9856356948 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2012 | ||||||||
| LastUpdateDate: | 01/04/2012 | ||||||||
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| AuthorizedOfficialLastName: | GAST | ||||||||
| AuthorizedOfficialFirstName: | CLARENCE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9856356943 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 1808849 | 05 | LA | MEDICAID |