Basic Information
Provider Information
NPI: 1265764302
EntityType: 2
ReplacementNPI:  
OrganizationName: UNITED SEATING AND MOBILITY
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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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: 6350 REGENCY PKWY STE 540
Address2:  
City: NORCROSS
State: GA
PostalCode: 300712338
CountryCode: US
TelephoneNumber: 6783924202
FaxNumber: 4045932934
Other Information
ProviderEnumerationDate: 01/30/2010
LastUpdateDate: 02/10/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: JOHNSON
AuthorizedOfficialFirstName: WALTER
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CREDENTIALING MANAGER
AuthorizedOfficialTelephone: 3144477515
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
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AuthorizedOfficialCredential:  
NPICertificationDate: 02/10/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
332B00000X132375LGBGAY SuppliersDurable Medical Equipment & Medical Supplies 

No ID Information.


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