Basic Information
| Provider Information | |||||||||
| NPI: | 1710086467 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOBILITY PLUS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3025 NATHAN LN | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323086289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8503864606 | ||||||||
| FaxNumber: | 8503856730 | ||||||||
| Practice Location | |||||||||
| Address1: | 3025 NATHAN LN | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323086289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8503864606 | ||||||||
| FaxNumber: | 8503856730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 06/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | KLEIN | ||||||||
| AuthorizedOfficialFirstName: | RUTHERFORD | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8503864606 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 1312079 | FL | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | R9614 | 01 | FL | BCBS OF FL PROVIDER ID | OTHER | 687713379 | 05 | FL | MEDICAID | 758735423B | 05 | GA | MEDICAID | 026731700 | 05 | FL | MEDICAID | 690474296 | 05 | FL | MEDICAID |