Basic Information
| Provider Information | |||||||||
| NPI: | 1730327883 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NATIONAL SEATING & MOBILITY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5959 SHALLOWFORD RD | ||||||||
| Address2: | SUITE 443 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374212285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237562268 | ||||||||
| FaxNumber: | 4232669690 | ||||||||
| Practice Location | |||||||||
| Address1: | 11003 BLUEGRASS PKWY STE 460 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402992392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022665213 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2009 | ||||||||
| LastUpdateDate: | 07/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | MATUKEWICZ | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 4237562268 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | 131999 | KY | N | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 10-12-CC-8625 | 01 | KY | KY CCSHCN PROGRAM | OTHER | 7100101240 | 05 | KY | MEDICAID | 1730327883 | 01 | IN | IN CHILDREN'S SPECIAL HEALTH CARE SERVICE | OTHER | 7100147890 | 01 | KY | KY EPSDT | OTHER | 100194330F | 05 | IN | MEDICAID |