Basic Information
| Provider Information | |||||||||
| NPI: | 1740293521 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNITED SEATING AND MOBILITY LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | NUMOTION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 2070 LITTLE HILLS EXPY | ||||||||
| Address2: | |||||||||
| City: | SAINT CHARLES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633013708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144477500 | ||||||||
| FaxNumber: | 3144477830 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 RESOURCE DR | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441311862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165395792 | ||||||||
| FaxNumber: | 2165395799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | WALTER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER LICENSURE AND CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 3144477515 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | 332B00000X | 1228434 | OH | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 7282299 | 01 | OH | AETNA NATIONAL NON-HMO | OTHER | 251910864 | 01 | OH | GREAT WEST LIFE & ANNUITY | OTHER | 276581 | 01 | OH | AETNA NATIONAL HMO | OTHER | 04155 | 01 | OH | PARAMOUNT HEALTH PLAN | OTHER | 407105 | 01 | OH | HUMANA CHOICE CARE | OTHER | 141330100 | 01 | OH | US DEPT OF LABOR | OTHER | 000000225965 | 01 | OH | ANTHEM BCBS OF OH | OTHER | 2650279 | 05 | OH | MEDICAID |