Basic Information
Provider Information | |||||||||
NPI: | 1972576882 | ||||||||
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 ROAD | ||||||||
Address2: | SUITE 443 | ||||||||
City: | CHATTANOOGA | ||||||||
State: | TN | ||||||||
PostalCode: | 372412245 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4237562268 | ||||||||
FaxNumber: | 4232669690 | ||||||||
Practice Location | |||||||||
Address1: | 2158 PLAINFIELD PIKE | ||||||||
Address2: | UNIT #3 | ||||||||
City: | CRANSTON | ||||||||
State: | RI | ||||||||
PostalCode: | 029212018 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4019468162 | ||||||||
FaxNumber: | 4019468950 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/10/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ANDERSON | ||||||||
AuthorizedOfficialFirstName: | P | ||||||||
AuthorizedOfficialMiddleName: | ROGER | ||||||||
AuthorizedOfficialTitleorPosition: | TREASURER CFO | ||||||||
AuthorizedOfficialTelephone: | 6155951115 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X |   |   | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies |   |
ID Information
ID | Type | State | Issuer | Description | NS49859 | 05 | RI |   | MEDICAID | 003121879 | 01 | CT | MEDICAID | OTHER |