Basic Information
Provider Information | |||||||||
NPI: | 1740603075 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NATIONAL SEATING & MOBILITY, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5959 SHALLOWFORD RD | ||||||||
Address2: | SUITE 443 | ||||||||
City: | CHATTANOOGA | ||||||||
State: | TN | ||||||||
PostalCode: | 374212285 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4237562268 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 3140 YORKMONT RD STE 500 | ||||||||
Address2: |   | ||||||||
City: | CHARLOTTE | ||||||||
State: | NC | ||||||||
PostalCode: | 282087372 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7043338431 | ||||||||
FaxNumber: | 7043335506 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/22/2014 | ||||||||
LastUpdateDate: | 01/10/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MATUKEWICZ | ||||||||
AuthorizedOfficialFirstName: | JEFFREY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CORPORATE SECRETARY | ||||||||
AuthorizedOfficialTelephone: | 4237562268 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/10/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171WH0202X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Contractor | Home Modifications | 171WV0202X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Contractor | Vehicle Modifications | 225CA2500X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | Assistive Technology Supplier | 332BC3200X |   |   | N |   | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | 171W00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Contractor |   | 332B00000X |   |   | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies |   |
ID Information
ID | Type | State | Issuer | Description | 1740603075 | 05 | NC |   | MEDICAID | DE3524 | 05 | SC |   | MEDICAID |