Basic Information
| Provider Information | |||||||||
| NPI: | 1417927997 | ||||||||
| 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: | 11975 SW HERMAN RD | ||||||||
| Address2: | |||||||||
| City: | TUALATIN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970628082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035821955 | ||||||||
| FaxNumber: | 5035821139 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 02/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | WALTER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING AND LICENSURE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3144477515 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | 332B00000X | 019878-90 | OR | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 228883 | 01 | OR | MARION POLK HEALTH PLAN | OTHER | 407099 | 01 | OR | HUMANA CHOICE CARE | OTHER | 141330100 | 01 | OR | US DEPT OF LABOR | OTHER | 228833 | 01 | OR | DOCS-OMAP | OTHER | 810070000 | 01 | OR | REGENCE BCBS OF OR | OTHER | 0178400001 | 01 | OR | PACIFICARE OF OR | OTHER | 228883 | 01 | OR | FAMILYCARE OR PREMIERCARE | OTHER | 247574 | 05 | OR | MEDICAID | 251910864 | 01 | OR | GREAT WEST LIFE & ANNUITY | OTHER | 276581 | 01 | OR | AETNA NATIONAL HMO | OTHER | 7282299 | 01 | OR | AETNA NATIONAL NON-HMO | OTHER | J0112-01 | 01 | OR | PACIFICSOURCE HEALTH PLAN | OTHER | 228811 | 01 | OR | MID ROGUE IPA | OTHER |