Basic Information
| Provider Information | |||||||||
| NPI: | 1356314900 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NATIONAL SEATING & MOBILITY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5959 SHALLOWFORD RD STE 443 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374212245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237562268 | ||||||||
| FaxNumber: | 4232669690 | ||||||||
| Practice Location | |||||||||
| Address1: | 4235 PONDEROSA AVE STE A | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921239701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586897070 | ||||||||
| FaxNumber: | 8586897071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2006 | ||||||||
| LastUpdateDate: | 09/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | MATUKEWICZ | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 4237562268 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 09/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 102113 | CA | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BC3200X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 1376516922 | 05 | CA | MEDICAID |