Basic Information
Provider Information | |||||||||
NPI: | 1720340003 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | COMFORT-N-MOBILITY, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3082 GULF BREEZE PKWY | ||||||||
Address2: |   | ||||||||
City: | GULF BREEZE | ||||||||
State: | FL | ||||||||
PostalCode: | 325633246 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8509345217 | ||||||||
FaxNumber: | 8509344771 | ||||||||
Practice Location | |||||||||
Address1: | 2317 E 15TH ST | ||||||||
Address2: |   | ||||||||
City: | PANAMA CITY | ||||||||
State: | FL | ||||||||
PostalCode: | 324056345 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8502575777 | ||||||||
FaxNumber: | 8502575238 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/12/2012 | ||||||||
LastUpdateDate: | 05/22/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BOHATKA | ||||||||
AuthorizedOfficialFirstName: | WILLIAM | ||||||||
AuthorizedOfficialMiddleName: | MARTIN | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 8509345217 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 1079 | FL | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies |   |
No ID Information.